How To Use CPT Code 11043

CPT 11043 is a medical procedure code for debridement of muscle and/or fascia, including any debridement of the epidermis, dermis, and subcutaneous tissue, for the first or only 20 cm2 or less. 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 11043 procedures.

1. What is CPT 11043?

CPT 11043 is a medical procedure code used to describe the surgical removal of dead or damaged tissue from muscle and/or fascia, including any debridement of the epidermis, dermis, and subcutaneous tissue, for the first or only 20 cm2 or less. This code is used by healthcare providers to accurately document and bill for this specific type of debridement procedure.

2. 11043 CPT code description

The official description of CPT code 11043 is: “Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less.”

3. Procedure

The CPT 11043 procedure involves the following steps:

1. The patient is appropriately prepped and anesthetized.
2. The provider performs prolonged cleansing of the wound involving the muscle and/or fascia.
3. Using appropriate instruments such as forceps and scissors, the provider removes the damaged tissues and necrotic material from the skin and muscle layer, which include skin, subcutaneous tissue, fascia, and muscle.
4. The provider excises 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 11043 services are those with wounds that require debridement of muscle and/or fascia, including any debridement of the epidermis, dermis, and subcutaneous tissue, for the first or only 20 cm2 or less. This may include patients with chronic wounds, such as pressure ulcers, diabetic ulcers, or venous stasis ulcers, as well as patients with acute wounds resulting from trauma or surgery.

5. When to use CPT code 11043

It is appropriate to bill the 11043 CPT code when the provider performs debridement of muscle and/or fascia, including any debridement of the epidermis, dermis, and subcutaneous tissue, for the first or only 20 cm2 or less. This code should be used when the debridement occurs down to the fascia and muscular layer.

6. Documentation requirements

To support a claim for CPT 11043, the following information should be documented:

• Patient’s medical history and relevant diagnoses
• Indication for the debridement procedure
• Size of the wound and the area of debridement
• Depth of the debridement, including the specific layers of tissue removed
• Details of the procedure, including instruments used and steps taken
• Post-procedure care, including wound dressing and any medications applied

7. Billing guidelines

When billing for CPT code 11043, it is important to follow the appropriate guidelines and rules. Use +11046 as an add-on code for each additional 20 cm2 of body surface. If the debridement is only for the first 20 cm2 of subcutaneous tissue including epidermis and dermis, see CPT 11042. If the debridement includes bone, see CPT 11044.

8. Historical information

CPT 11043 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, subcutaneous tissue, and muscle.”

9. Similar codes to CPT 11043

Five similar codes to CPT 11043 and how they differentiate are:

• CPT 11042: Debridement of only the first 20 cm2 of subcutaneous tissue, including epidermis and dermis.
• CPT 11044: Debridement that includes bone.
• CPT 11045: Debridement of skin and subcutaneous tissue for each additional 20 cm2 or part thereof.
• CPT 11046: Debridement of muscle and/or fascia for each additional 20 cm2 or part thereof.
• CPT 11047: Debridement of bone for each additional 20 cm2 or part thereof.

10. Examples

Here are 10 detailed examples of CPT code 11043 procedures:

1. Debridement of a 15 cm2 pressure ulcer on the sacrum involving muscle and fascia.
2. Debridement of a 20 cm2 diabetic foot ulcer with involvement of muscle and fascia.
3. Debridement of a 10 cm2 traumatic wound on the leg with muscle and fascia involvement.
4. Debridement of an 18 cm2 venous stasis ulcer on the lower leg involving muscle and fascia.
5. Debridement of a 12 cm2 post-surgical wound infection on the abdomen with muscle and fascia involvement.
6. Debridement of a 16 cm2 necrotizing fasciitis wound on the arm involving muscle and fascia.
7. Debridement of a 20 cm2 burn wound on the back with muscle and fascia involvement.
8. Debridement of a 14 cm2 chronic non-healing wound on the foot with muscle and fascia involvement.
9. Debridement of a 19 cm2 infected wound on the thigh with muscle and fascia involvement.
10. Debridement of a 17 cm2 pressure ulcer on the heel with muscle and fascia involvement.