Debridement

Good Afternoon

I am wondering if anyone has any detailed information about the deletion of 11040 and 11041. These were regular debridements, different thickness but were replaced with burn debridement codes. So what about debridement of non burn wounds, such as an abrasion? 11042 was revised and now starts at the subcutaneous level, which would eliminate a simple abrasion. I am wondering if this is their subtle way to say debridements of just the dermis and epidermis are now incidental to the E/M. What is your opinion? Or knowledge of this? Are you aware of any sites I can reference?

Thank you
Ginger

debridement

three new cross references have been added following code 11012. The first instructs codes 97597 and 97598 for debridement of skin (epidermis and/or dermis only.

Debridement

But the 97597 and 97598 are extreme. They include high pressure water jets, sharp debride, whirlpools and all sorts of goodies? Wouldn't this be a bit extreme for a wee abrasion? Or am I not reading this correctly?

interesting

http://www.msha.gov/30cfr/50.20-3.HTM

A bit extreme if not medically necessary.

Debridement

That is why I am wondering how far to go with this. The way I am reading the 9579_ codes, I feel like that would be up coding with all that is involved. That is why I wonder if they removed the simple debrides and now they are considered incidental to.

2011 debridement changes

Debridement codes for partial and full thickness skin have simply been deleted while other debridement codes have been revised to clarify the depth of tissue debrided beyond skin, including all superficial layers above. Debridement of skin alone is reported with active wound care management codes in the medicine chapter.

The Integumentary System subsection has been expanded to include new guidelines to define wound debridement and surface area related to debridement of the subcutaneous tissue, biofilm, epidermis, dermis, muscle, and/or fascia. The subheading Excision-Debridement is replaced by only the term Debridement. CPT® guideline revisions have been made in the Skin Replacement Surgery and Skin Substitutes, the Surgical and Application of Skin Replacements, and the Skin Substitute subsections.

Coding for Debridement

• Debridement is separately reported when it is the only
  procedure performed if guidelines are met


• Debridement is included in the repair or excision codes
  unless gross contamination and appreciable amounts of
  devitalized and contamination tissue are removed


• Sharp debridement without immediate primary closure is
  reported separately if no deeper structures are repaired


• Documentation is the key to appropriate code
  selection. The depth of debridement, manner of
  debridement, presence of gross contamination and
  the tissues involved in the debridement or depth of
  debridement drive the coding choice.

2011 Changes in Debridement Coding

• Surgical wound debridement codes 11040 and 11041 are deleted.
  Report 97597 and 97598 for debridement of epidermis or dermis.


• Debridement is now coded based on depth and diameter


• The debridement codes were modified to provide a method of
  reporting for the more extensive debridement procedures
  required for MRSA and other complex wound infections


• For multiple wounds of the same depth, report the combined
  sum of the surface area debrided


• For multiple wounds of different depths, report sums of
  “different depth” debridement procedures


• Use the 59 modifier for different depth wound debridements
  (11042, 11045 or 11044 at same surgical session)

2011 Debridement Codes

• 11042 – debridement, subcutaneous tissue (includes
  epidermis and dermis, if performed); first 20 sq cm or less


• 11045 – each additional 20 sq cm, or part thereof (add on code
  to be listed in addition to code for primary procedure)


• 11043 – debridement, muscle and fascia (includes epidermis
  and dermis, and subcutaneous tissues, if performed); first 20
  sq cm or less


• 11046 – each additional 20 sq cm, or part thereof (add on code
  to be listed in addition to code for primary procedure)


• 11044 – debridement, bone (includes epidermis, dermis,
  subcutaneous tissue, muscle and/or fascia, if performed); first
  20 sq cm or less


• 11047 – each additional 20 sq cm, or part thereof (add on code
  to be listed in addition to code for primary procedure)

CPT® codes 15002-15005

• Not to be reported for removal of nonviable tissue or
  debris in a chronic wound when wound is left to heal
  by secondary intention


• Not to be reported for removal of nonviable tissue or
  debris in a chronic wound when wound is left to heal
  by secondary intention



• The intent of these codes is to heal the wound by
  primary intention or by negative wound therapy



• Report complex repairs, adjacent tissue transfer, flaps
  and grafts separately