Debridement is a medical procedure for treating a wound within the skin. It involves thoroughly cleaning the wound and removing all hyperkeratotic (thickened skin or callus), infected, and nonviable (necrotic or dead) tissue, foreign debris, and residual material from dressings.
Debridement Coding Guidelines
Debridement of a wound, performed before the application of a topical or local anesthesia is billed with CPT codes 11042 – 11047. Wound debridements (11042-11047) are reported by depth of tissue that is removed and by surface area of the wound. When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of those wounds that are at the same depth, but don’t combine sums from different depths. See CPT coding guidance for correct use of the coding.
Do not report 11042 -11047 in conjunction with 97597-97602 for the same wound.
CPT code 11043, 11046 and 11044, 11047 may only be billed in place of service inpatient hospital, outpatient hospital or ambulatory surgical center (ASC).
CPT codes 11043, 11046 and 11044, 11047 are codes that describe deep debridement of the muscle and bone.
Surgical Debridement Codes (CPT 11042-11047)
Surgical debridement occurs only if material has been excised and is typically reported for the treatment of a wound to clear and maintain the site free of devitalized tissue including necrosis, eschar, slough, infected tissue, abnormal granulation tissue etc., to the margins of viable tissue.
Surgical excision includes going slightly beyond the point of visible necrotic tissue until viable bleeding tissue is encountered in some cases. The use of a sharp instrument does not necessarily substantiate the performance of surgical excisional debridement. Unless the medical record shows that a surgical excisional debridement has been performed, debridements should be coded with either selective or non-selective codes (97022, 97036, 97597, 97598, or 97602).
Surgical debridement codes as performed by physicians and qualified non-physician practitioners licensed by the state to perform those services are reported by depth of tissue removed and by surface area of the wound. These codes can be very effective but represent extensive debridement, often painful to the patient, and could require complex, surgical procedures and sometimes require the use of general anesthesia. Source – Billing and Coding Guidelines for Wound Care
Reasons for Denial
- Performing deep debridement in POS other than inpatient hospital, outpatient hospital or ASC.
- Billing of debridement by unqualified personal.
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