. 0000008118 00000 n Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with Procedures involving the wrist and/or ankle are reported with codes that include arm or leg in the descriptor. 0000001292 00000 n In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. Replacement material, graft size, multiple wounds all these factors and more [], Dont miss pregnancy impact. 0000020105 00000 n Codes 15002-15005 apply specifically to describe the work of "preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy," according to CPT guidelines. These materials contain Current Dental Terminology (CDTTM), copyright© 2022 American Dental Association (ADA). This note should describe the anatomical location treated, the instruments used, anesthesia used if required, the type of tissue removed from the wound, the depth and area of the wound and the immediate post procedure care and follow-up instructions. and monitoring is occurring. American Hospital Association ("AHA"), Reader Question: Distinguish Additional Lesion Excision Method, CCI Edits: Navigate Surgery Bundles That Could Compromise Your Pay, ICD-10 Changes: Master Guidelines for Infection, Sepsis. When can I report a debridement in addition to a graft? damages arising out of the use of such information, product, or process. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. 0000000936 00000 n Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not If a physician uses a curette to debride slough on the surface of the wound is that classified as subcutaneous or non-surgical? 0000002478 00000 n Skin replacement surgery consists of two basic steps: surgical preparation of the recipient site and placement of the graft with fixation. 0000010407 00000 n iC>:D~c~V*H0"Q%L]5CB Debridement of diabetic foot ulcers more frequently than once every seven (7) days, for a period longer than three (3) months may not be reasonable and necessary. If infection has developed, the patient's response to this infection should be described. In addition to the type of graft material, the surgeon should also document site preparation and wound size, and number and location of grafts, according to Beresh. Coding Rationale The physician excised a malignant lesion from the patient's lower leg followed by closure with a split-thickness graft. He is an alumnus of York College of Pennsylvania and Clemson University. Should we drop Mods 59s and instead use XSs, for both 11042 and 11043? Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Revenue Codes are equally subject to this coverage determination. Question: Do not report 11042 -11047 in conjunction with 97597-97602 for the . Service: The work described by these codes involves preparing a clean, viable wound surface for graft placement to heal by primary intention (not secondary intention). Debridement Debridement of subcutaneous tissue (e.g., Current Procedural Terminology (CPT) codes 11042 and 11045, if appropriate) is considered Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. Add together the surface area of multiple . Skin was closed with 6-0 Prolene. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE, DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), 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, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS, 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, TOTAL WOUND(S) SURFACE AREA; EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), Some older versions have been archived. HWAnl))1p9CK,q@:(#"ET.OSnt$v\^lt6btT 9A'w>$bg71w= Y)s.girVu^T_N'%u7Ag>f|vsQ lCN}uCjdgIKLYvO0>E,bRpUuCXX_"RkdEN""/@1] $' O*o5-OEJmq@Hc^VVl 0 CPT codes, descriptions and other data only are copyright 2022 American Medical Association. KarenZupko & Associates, Inc. 2023 | All Rights Reserved. Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. Applicable FARS/HHSARS apply. H|Wd5W5Re'c X!XFk4K|?>_/]%zWCBJ7 .`u}}`JWJz=^o\z9e~BT AT9 vqdYkh%BprY-.%V)["[n . I96w4Ak1;*8LMZI;Oe1\s &$W2DQY#"E"2$*85lm"HIl]JW)"4#F3^6F8?1HtaG]xuA*D::!83P|MnKC*{:?qk,nlG,d=atI'0 I2nC Answer: CPT considers debridement 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.. My coder says that 11043/11046 is included in 15271 and we can't separately bill for them with 15271. To report these codes, the surgeons documentation should demonstrate work such as removing nonviable tissue and/or releasing a scar contracture. article does not apply to that Bill Type. The procedure is essential for wounds that aren . Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). In the presence of documented significant ischemic disease with necrotic ulceration, extensive and definitive debridement may be required. To report these codes, the surgeons documentation should demonstrate work such as removing nonviable tissue and/or releasing a scar contracture. Applicable Federal Acquisition Regulation Clauses (FARS)/Department of Defense Federal Acquisition Regulation supplement (DFARS) Restrictions Apply to Government Use. Bill types and Revenue codes have been removed from this article. Be sure that the documentation supports that the wound area covered by the skin substitute was 20 sq. jQuery(function() { _initLayerSlider( '#layerslider_57_r6v94to757da', {createdWith: '6.8.2', sliderVersion: '6.9.2', allowFullscreen: true, pauseOnHover: 'enabled', skin: 'v6', sliderFadeInDuration: 350, useSrcset: true, skinsPath: 'https://karenzupko.com/wp-content/plugins/LayerSlider/assets/static/layerslider/skins/', performanceMode: true}); }); KarenZupko & Associates, Inc. 2023 | All Rights Reserved. o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm endstream endobj startxref The Centers for Medicare & Medicaid Services (CMS), the federal agency responsible for administration of the Medicare, Article document IDs begin with the letter "A" (e.g., A12345). [ 4"!|F. k However, please note that once a group is collapsed, the browser Find function will not find codes in that group. copied without the express written consent of the AHA. Trunk, arms, legs cm. Federal government websites often end in .gov or .mil. endstream endobj 1254 0 obj <>/Metadata 102 0 R/OCProperties<>/OCGs[1280 0 R]>>/Outlines 119 0 R/PageLayout/SinglePage/Pages 1245 0 R/StructTreeRoot 186 0 R/Type/Catalog>> endobj 1255 0 obj <>/ExtGState<>/Font<>/Pattern<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 1256 0 obj <>stream The National Correct Coding Initiative (NCCI) bundles skin substitute graft codes 15271-+15277 with skin and subcutaneous debridement code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less). Reproduced with permission. Determining the wound location and surface area is important in order to select the appropriate CPT code. I work in an acute care center with a burn unit and . When performing debridement of a single wound, report depth using the deepest level of tissue removed. Answer: Answer: %%EOF reasonable efforts to provide accurate coding information, this information should not be construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. CDT is a trademark of the ADA. To code the excision, look in the index for the term Lesion, then Skin. CPT codes 11042-11047 should be used for debridement of relatively localized areas depending upon the involvement of contiguous underlying structures. Q4102 . If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. cm. Integumentary Procedures: 3 Tips Guide Coding for Skin Substitute Grafts, 3 Tips Guide Coding for Skin Substitute Grafts, Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (, 15002 and +15003 for trunk, arms, legs (including wrist or ankle), 15004 and +15005 for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, Non-autologous human skin (dermal or epidermal, cellular and acellular) grafts, including allografts (from a person other than the patient) and homografts (from cadavers), Non-human skin substitute grafts such as xenografts (from another animal such as pig), Biological products that form a sheet scaffolding for skin growth. Based on what I have read in the Official Guidelines for Coding and Reporting and Coding Clinic for ICD-9-CM, I believe that I should report two separate codes. In your example, you will be closing the wound. Instructions for enabling "JavaScript" can be found here. cm or less). Code 86.22, Excisional debridement, was defined as the "surgical removal or cutting away of devitalized tissue, necrosis, or slough," which could be performed in the operating room, emergency room, or at the patient's bedside. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. Skin Lesion Excision Wait for Pathology? hVmo6+ER|l%v5/:Bm#e'b|x;CA\X&V@[ ElBdd B()"8$^DHhFTDv):7^L]c"BJ#=,'$T#BJ! In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. For example, debridement of two ulcers on the foot to the level of subcutaneous tissue, total area of 6 sq cm should be billed as CPT code 11042 with unit of service of 1. Remember: Wound surface area is what you should consider when selecting the code, not the size of the graft, cautions Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. If the documentation supports that 20 sq. That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. Reduction of pressure and/or control of infection will facilitate healing and may reduce the need for repeated debridement services. 0000044306 00000 n 0000013585 00000 n accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the End Users do not act for or on behalf of the CMS. At a minimum, the Progress Report must document the continuing skilled assessment of wound healing as it has progressed since the evaluation or last Progress Report. Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. The care of minor wounds (post-operative, traumatic, or otherwise) is incidental to other covered services. The treatment plan for a patient who requires frequent repeated debridement should be reevaluated, to ensure that pressure reduction and infection control have been adequately addressed. j0 W0 Answer: Not exactly. The scope of this license is determined by the AMA, the copyright holder. No fee schedules, basic unit, relative values or related listings are included in CPT. Each pair of codes identifies the size of the defect created by the surgical preparation, with the first code (15002 or 15004) describing the first 100 sq cm for adults and children aged 10 and up, or 1 percent of body surface area for children under 10 years of age, including infants. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. The second code in each set (+15003 and +15005) are add-on codes that you should report for defect area beyond the initial size (for each additional 100 sq cm or 1 percent of body area or part thereof). 6. All rights reserved. The physician documentation is the key to being able to support both codes. In your example, you will be closing the wound. When the patient has required more debridement services per wound than defined below, the medical record must include documentation reflecting neuropathic, vascular, metabolic, or other comorbid conditions. cm of the total 85.25 sq. culture and sensitivity), osteomyelitis (e.g. 3. For patients with chronic wounds being treated in an outpatient setting, services beyond the fifth surgical debridement, CPT code 11043, 11046 and/or 11044, 11047, per patient, per year, per wound may require a medical review of records demonstrating the medical reasonableness and necessity. 0000016569 00000 n Answer: Debridement is considered a separately reportable procedure when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue is removed, or when debridement is carried out separately without an immediate primary closure. To bill for an Apligraf (HCPCS Q4101) package (equal to 44-sq. 8u-0=*.tCOeF8h`TLeHRzLco`@X(d9rFdcG VA,P&l 0000006208 00000 n 0000012252 00000 n Code Debridement by Documented Depth and Area When reporting debridement of a bedsore, code selection depends on the depth of debridement and total area debrided: Depth to subcutaneous tissue (to the depth of blood vessels and nerves): 11042 (first 20 sq cm) and +11045 (each additional 20 sq cm, or part thereof)