Understanding WHICH code(s) to use and WHEN:
1. Coding is based on the depth of tissue debrided, the type of tissue removed and the debrided wound surface area L x W x D in square cm (minimum of Length X Width in sq cm).
2. Debridement codes should be based on the wound surface area actually debrided. If the entire wound is actually debrided, then the entire wound surface area is measured. If only a portion of the wound is actually debrided, then only that portion is measured to calculate wound surface area for debridement purposes.
3. When multiple wounds are debrided to the same depth and the same type of tissue is removed, add all of the wound surfaces together to reach a total sq cm for coding. Do not code each wound individually.
4. When multiple wounds are debrided at different depths and different types of tissue are removed, then use multiple codes.
5. Codes used back in 2010 – 11040 and 11041 have been deleted and are history. The “Therapy” codes for “Medical” (formerly “Selective”) debridement 97597 and 97598 are now used. Therapy codes, yes, but DPM’s can bill for it.
6. The codes starting from 11042 – 11047 have ALL been revised with new descriptions. It is recommended that you state the type of instrument used to do the debridement. The global periods (10 days) for 11043 and 11044 have been deleted.
Explanation of “BASE” codes and “ADD-ON” codes, each should be listed separately:
- 97597 – Base code, the total wound surface area, of one or multiple, first 20 sq cm or less.
- +97598 – Add-on code, the total wound surface area, of one or multiple, each additional 20 sq cm or part thereof.
Description: Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), open wound (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session (sharp “selective” debridement means the removal of the visible layer of necrotic/devitalized/non-viable “stuff” impairing healing that would not require the use of anesthesia) Active wound care management.
- 11042 – Base code, Subcutaneous tissue, surface area first 20 sq cm or less.
- +11045 – Add-on code, Subcutaneous tissue, surface area each additional 20 sq cm or part thereof.
Description: Surgical debridement, subcutaneous tissue (includes epidermis, dermis, if performed)
- 11043 – Base code, Muscle, muscle fascia, surface area first 20 sq cm or less.
- +11046 – Add-on code, Muscle, muscle fascia, surface area each additional 20 sq cm or part thereof.
Description: Surgical debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed)
- 11044 – Base code, bone, surface area first 20 sq cm or less.
- +11047 – Add-on code, bone, surface area each additional 20 sq cm or part thereof.
Description: Surgical debridement, bone (includes epidermis, dermis, and subcutaneous tissue, muscle, and/or fascia, if performed)
Examples of correct code selection:
Scenario 1: One wound, 15 sq cm, sub-q tissue debrided/removed “PLUS” one wound, L leg, 15 sq cm, sub-q tissue debrided/removed. Since similar tissue was debrided/removed (same depth), the combined total surface area = 30 sq cm. Code as: 11042 1 unit and 11045 1 unit.
Scenario 2: One wound, 8 sq cm, necrotic/devitalized epidermis/dermis tissue debrided/ removed. Code as: 97597 1 unit.
Scenario 3: One wound, 10 sq cm, muscle/muscle fascia debrided/removed “AND” one wound 15 sq cm, necrotic/devitalized epidermis/dermis tissue debrided/ removed. When multiple wounds are debrided at different depths and different types of tissue are removed, use multiple codes. (Never use the -59 modifier on “Add-on” codes, only Base codes) Code as: 11043 1 unit and 97597-59 I unit.
SOURCE: CPT AMA and CPT Assistant
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