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CPT Code 11042 | Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 11042 is a medical code for skin debridement procedures. The 11042 code can be reported when necrotic subcutaneous tissue is removed, even if the ulcer or incision extends to the bone. CPT 11042 won’t be reimbursed when only fibrin is removed.

In the treatment of wounds, surgical debridement can typically be used to remove and keep the location free of necrotic tissue, eschar, slough, infected tissue, aberrant granulation tissue, and so on, to the boundaries of viable tissue. Only after material can remove from the patient can surgical debridement be performed.

Surgical excisional debridement does not always necessitate using a sharp instrument. Instead, surgeons must sometimes look beyond the apparent necrosis to find live bleeding tissue.

Surgical debridement codes are generated based on the amount of tissue removed during surgery and the wound size.

Non-physician practitioners can provide the CPT code 11042 procedure with a state license. They can provide benefits, but they frequently necessitate extensive debridement, which causes pain for the patient. In addition, they may require invasive surgical procedures requiring general anesthesia.

Selective debridement removes deviated tissue or tissue obstructing healing from a wound at the edge of viable tissue. Bruising and stiffness may occur from time to time. 

Conservative sharp debridement is a simple outpatient procedure that does not require using an anesthetic.

Instead, scalpels, scissors, tweezers or forceps, and or forceps tweezers can use to remove visibly necrotic or devitalized tissue. During this procedure, there is usually no bleeding.

Powerful water jet Pulsed lavage removes debris from a wound by applying a shearing effect with a water jet. This is possible with or without pulsation. Some electric pulsatile irrigation devices use suction to remove any remaining material from the wound after watering.

These debridement procedures can frequently perform on high-risk patients. CPT code 11042 requires documenting the entire surface area (square centimeters).

During a wound debridement procedure, infected, damaged, or dead tissue removes to promote healing.

Debridement can typically link to wounds, ulcers, infections, and traumas and can be a reason to perform the CPT 11042 procedure. The operation may also be included in the treatment of fractures and can charge separately. In addition, descriptors can use to pinpoint the location of treatment.

The total wound surface area is combined when many wounds can cause debris to the same depth. When the depths of two or more wounds differ, each one is assigned a unique code.

In treating wounds, the CPT code 11042 procedure can remove and keep the location free of necrotic tissue, eschar, slough, infected tissue, aberrant granulation tissue, and so on, to the boundaries of viable tissue.

Surgeons must sometimes look beyond the apparent necrosis to find live bleeding tissue. Surgical excisional debridement does not always necessitate the use of a sharp instrument. 

Surgical debridement procedures, like the 11042 CPT code, should also be documented, including information about the patient’s medical history, the type of anesthesia used, and how the wounds can repair during the surgery.

11042 CPT Code Description

CTP code 11042 can be reported for the removal of necrotic subcutaneous tissue. CPT 11042 is officially described by CPT’s manual as: “Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.”

The 11042 CPT code won’t be paid when only fibrin is removed because of the time it takes for skin and subcutaneous tissues to regrow. Removing them from a single lesion is not an option.

CPT code 11042 applies to wound debridement, including the subcutaneous tissue. Although “subcutaneous tissue debridement” has been expanded to include the epidermis and dermis, it still refers to the first 20 cm2 or less.

The 11042 CPT code, like CPT 97597 and CPT 97598, refers to the aggregate size of comparable wounds for the first 20 cm2 or less (depending on the type of tissue debrided).

Billing Guidelines For CPT Code 11042

CPT 11042 can be billed when all of the subcutaneous tissue is removed from a lesion with clearly visible bone. It is because the incision only removed subcutaneous tissue.

Report CPT 97597 or CPT 97598 instead of CPT code 11042 for skin debridement (for example, epidermis or/and dermis only).

Wounds can count according to the total area of their 20 cm2 surface rather than the total number of surface wounds. So if you’ve removed different types of tissue from multiple injuries, group them if they’re all the same type of wound.

CPT 11042 – CPT 11047 are only for debridement below the dermis. The tissue area removed increases when the same tissue depth can draw from different anatomic locations.

Therefore, only the most profound degree of debridement can document when multiple tissue levels can withdraw from the same anatomic region.

Add up the surface area of each one when there are multiple wounds of the same depth. Measurements and documentation should include in standard operating procedures (SOPs).

Creating a self-auditing tool, such as a checklist, will make it simple to determine what information is missing from the medical record. Before responding to requests for additional paperwork, providers should double-check their invoices and supporting documentation (ADRs).

Wound healing can speed up by removing necrotic and dead tissue from the wound with active wound care. When billing CPT 97597, CPT 97598, or CPT 97602, each therapy must explain the method and technique used (such as a scalpel, scissors, 44 gauzes, wet-to-dry, or enzyme).

Furthermore, the documentation for CPT code 11042 should include information about the wound’s size, depth, stage, bed features, and the type of tissue or substance removed. The accompanying documentation must be by the billing code.

When only non-surgical cleaning of the ulcer site, with or without surgical dressings, is performed, E/M codes should use instead of debridement codes, and this service should be billed accordingly (s).

These codes can treat skin ulcers, localized dermal infections, and diseases affecting neighboring deeper systems, such as those caused by road abrasions.

When an early debridement procedure combines more extensive surgery, the phased surgical intervention is more complicated than the actual operation (such as the definitive treatment of an open fracture).

Non-viable tissue can be removed while minimizing bleeding and the overall size of the lesion using a technique known as selective debridement. Non-selective wound debridement targets non-viable tissue rather than the wound itself.

How To Use Modifier 25 With CPT 11042

Because only one graft/skin substitute can use at a time, each anatomic site can only use one main graft/skin substitution code.

Wound care (CPT 97597 – CPT 97598) and wound debridement codes can be reported for secondary healing wound debridement (CPT 11042 – CPT 11047).

If the practitioner treats wounds in addition to other conditions, an E/M service can be reported with modifier 25. Only the wound care codes should report if the primary reason for the visit is to receive wound care treatment.

Depending on the amount of tissue removed and the total length of the incisions, you can combine any two CPT codes from 11042 to 11047. In addition, each primary debridement code can separate by 59 modifiers (versus add-on codes).

A specific procedural notation in the patient’s medical record should include. Documentation must demonstrate the medical necessity of providing wound care therapies.

Reimbursement

CPT code 11042 won’t be reimbursed when only fibrin is eliminated. Immersion hydrotherapy (CPT 97022 and CPT 97036) can be used in conjunction with a more selective debridement procedure.

Because CPT 97597 and CPT 97598 cover immersion hydrotherapy, it is not considered separately reimbursable .

Several insurance companies, including Medicare, cover wound therapy. Patients undergoing wound treatment frequently have underlying medical issues that must address concurrently. They might also need additional medicines like education and care coordination.

Example 1

A calf ulcer patient required necrotic subcutaneous tissue debridement. The case’s identification codes are CPT 11042 and CPT 11045. When the debridement finished, the area was 5 cm by 5 cm. The final measurement of 5 cm by 5 cm because the entire area was clear of debris (25 sq cm).

Example 2

A 4 cm by 4 cm ulcer on this patient’s calf was healing at more than 50%. According to the surgeon, a 1 cm by 1 cm portion of necrotic tissue was debrided. The code can determine by the 1 cm x 1 cm portion (1 sq. cm). CPT code 11042 can be reported.

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