Debridement with Surgical Procedures

Does anyone have any documentation that they can share with me stating whether you may or may not separately report a minimal debridement with surgical procedures?

I have a client that wants to bill the debridement codes with many ortho procedures (THA, revisions, etc) and since CCI does not bundle them they want documentation that states that the debridement shouldn't be separately reported. The debridements that they are wanting to report are minimal debridements, that to me, appear inherent to what they are doing.

Thanks, Jen

re: Debridement with Surgical Procedures

I would download the NCCI manual for Ortho. (On CMS's website, search in google for it). I suspect the manual states site preparation is part of procedures.

re: Debridement with Surgical Procedures

Below are just some of the common policies found in the National Correct Coding Policy Manual that you should be aware of. I highly recommend that every coder read the entire manual.

•Coding based on standards of medical practice. Any activities that are integral to a procedure are considered to be included in each surgical code. Some examples of services that are integral to all codes are:
- Cleansing, shaving, and prepping of skin
- Draping, prepping and positioning of the patient
- Insertion of IV access for medication
- Anesthesia administered by the physician performing the procedure
- Surgical approach including: identification of anatomical landmarks, incision & evaluation/exploration of surgical field, simple debridement of traumatized tissue, lysis of simple adhesions and isolation of structures that are limiting access to the surgical field.
- Wound irrigation and surgical cultures
- Insertion and removal of drains, suction devices, dressings and pumps into same site
- Surgical closure

Generally, if a service is necessary to successfully accomplish a procedure and failure to perform it would compromise the success of the procedure, it is considered to be an integral part – bundled – and should not be billed separately.

re: Debridement with Surgical Procedures

Thanks everyone. I was able to site sources with your help.

Per CPT: Debridement is considered a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.

Chapter 1, Part B of the NCCI manual clearly state that the “surgical approach including identification of anatomical landmarks, incision, evaluation of the surgical field, debridement of traumatized tissue, lysis of adhesions, and isolation of structures limiting access to the surgical field such as bone, blood vessels, nerve, and muscles including stimulation for identification or monitoring” are integral to the primary procedure.

Chapter 1, Part B, section 6 states, “If a definitive surgical procedure requires access through diseased tissue (e.g., necrotic skin, abscess, hematoma, seroma), a separate service for this access (e.g., debridement, incision and drainage) is not separately reportable.”

Chapter 1, Part B, section 9 states, “…debridement of tissue in the surgical field integral to the completion of another musculoskeletal procedure is not separately reportable. For example, debridement of muscle and/or bone (CPT® codes 11043-11044, 11046-11047) associated with excision of a tumor of bone is not separately reportable. Similarly, debridement of tissue superficial (e.g., CPT® codes 11042, 11045, 11720-11721, 97597, 97598) to, but in the surgical field, of a musculoskeletal procedure is not separately reportable.”