How To Use CPT Code 11042

CPT 11042 refers to the debridement of subcutaneous tissue, including the epidermis and dermis, up to the first 20 sq cm. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 11042 procedures.

1. What is CPT 11042?

CPT 11042 is a medical billing code used to describe the surgical removal of dead or infected tissue from the subcutaneous layer of the skin, including the epidermis and dermis, up to the first 20 sq cm. This procedure is performed to promote healing and prevent infection in patients with wounds or ulcers.

2. 11042 CPT code description

The official description of CPT code 11042 is: “Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.”

3. Procedure

The CPT 11042 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider performs prolonged cleansing of the skin and subcutaneous wound.
3. Using surgical instruments such as forceps and scissors, the provider removes infected or dead tissue material from the wound.
4. Debridement continues until viable tissue is visible, including excising tissue from the wound until healthy bleeding is observed on the skin edges.
5. Bleeding is controlled, an antibiotic is applied, and the wound is dressed.

4. Qualifying circumstances

Patients eligible to receive CPT 11042 services are those with wounds or ulcers that require debridement of subcutaneous tissue, including the epidermis and dermis, up to the first 20 sq cm. This may include patients with diabetic ulcers, pressure ulcers, venous stasis ulcers, or traumatic wounds. The procedure is performed to promote healing and prevent infection in these patients.

5. When to use CPT code 11042

It is appropriate to bill the 11042 CPT code when the provider performs debridement of subcutaneous tissue, including the epidermis and dermis, up to the first 20 sq cm. This code should be used for patients with wounds or ulcers that require this level of debridement to promote healing and prevent infection.

6. Documentation requirements

To support a claim for CPT 11042, the following information should be documented:

• Patient’s medical history and physical examination findings
• Indication for the debridement procedure
• Description of the wound or ulcer, including size, depth, and location
• Details of the debridement procedure, including the instruments used and the extent of tissue removal
• Observations of viable tissue and healthy bleeding on the skin edges
• Post-procedure care, including bleeding control, antibiotic application, and wound dressing

7. Billing guidelines

When billing for CPT code 11042, keep in mind the following guidelines and rules:

• Use +11045 as an add-on code for each additional 20 sq cm of body surface.
• If the debridement includes muscle and/or fascia in addition to subcutaneous tissue, dermis, and epidermis, see CPT 11043.
• If the debridement includes bone, see CPT 11044.
• For debridement of skin (i.e., epidermis and/or dermis only), see CPT codes 97597 and 97598.

8. Historical information

CPT 11042 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2011, with the previous descriptor being “Debridement; skin, and subcutaneous tissue.”

9. Similar codes to CPT 11042

Five similar codes to CPT 11042 and how they differentiate are:

• CPT 11043: Includes debridement of muscle and/or fascia in addition to subcutaneous tissue, dermis, and epidermis.
• CPT 11044: Includes debridement of bone in addition to other tissue layers.
• CPT 97597: Debridement of the upper layer(s) of skin (dermis and epidermis) only, up to the first 20 sq cm.
• CPT 97598: Debridement of the upper layer(s) of skin (dermis and epidermis) only, for each additional 20 sq cm.
• CPT +11045: Add-on code for each additional 20 sq cm of body surface when billing for CPT 11042.

10. Examples

Here are 10 detailed examples of CPT code 11042 procedures:

1. Debridement of a diabetic foot ulcer measuring 15 sq cm, involving subcutaneous tissue and epidermis.
2. Debridement of a pressure ulcer on the sacrum measuring 18 sq cm, involving subcutaneous tissue, dermis, and epidermis.
3. Debridement of a venous stasis ulcer on the lower leg measuring 20 sq cm, involving subcutaneous tissue and dermis.
4. Debridement of a traumatic wound on the forearm measuring 10 sq cm, involving subcutaneous tissue, dermis, and epidermis.
5. Debridement of a non-healing surgical wound on the abdomen measuring 12 sq cm, involving subcutaneous tissue and epidermis.
6. Debridement of an infected burn wound on the thigh measuring 16 sq cm, involving subcutaneous tissue, dermis, and epidermis.
7. Debridement of a necrotic tissue in a wound on the calf measuring 20 sq cm, involving subcutaneous tissue and dermis.
8. Debridement of a non-healing wound on the heel measuring 8 sq cm, involving subcutaneous tissue, dermis, and epidermis.
9. Debridement of an infected wound on the back measuring 14 sq cm, involving subcutaneous tissue and epidermis.
10. Debridement of a pressure ulcer on the buttock measuring 19 sq cm, involving subcutaneous tissue, dermis, and epidermis.