(2023) How To Bill The Wound Debridement CPT Codes
Wound debridement can be billed using CPT codes 11042 until 11047. For more extensive wound debridement services, you can use 97597, 97598, and 97602. Here are the the descriptions of the codes and billing guidelines for the CPT codes for wound debridement.
11042 CPT Code
CPT code 11042 is used when removing necrotic subcutaneous tissue. It does not cover reimbursement if only fibrin is removed. This code involves the removal of epidermis, dermis and subcutaneous layer from the twenty centimeters of skin. It also includes debridement of wounds within that area.
11043 CPT Code
CPT code 11043 is assigned to wound debridement that goes beyond the epidermis and subcutaneous tissue. Additional layers of tissue must be removed for this procedure.
11044 CPT Code
CPT code 11044 is used when continuous debridement of tissue is required for wounds than 20 square centimeters. It can be used in combination with debridement codes like 11042 (for the 20 square centimeters) and 11046 (for the first 20 square centimeters of subcutaneous tissue) to account for any remaining area.
11045 CPT Code
This code provides clarity, on how these CPT codes utilized in wound care debridement procedures.
11046 CPT Code
You can utilize the CPT code 11046 to remove both the epidermis and dermis if required, during the process of debriding tissue. It’s important to note that this specific code includes the removal of tissue, along, with the skin.
11047 CPT Code
The CPT code 11047 covers the removal of damaged tissue from a 20 cm² area, including the skin, underlying tissues, muscles and connective tissue. Please include this amount in the invoice, for CPT code 11044.
97597 CPT Code
You may use CPT 97597 if damaged or dead tissue is removed from an open wound. This can be done with sharp debridement, suction or a high pressure waterjet. The wounds can be up to 20 sq cm.
97598 CPT Code
CPT 97597 is the add-on code for CPT 97597 and can only be billed in combination with this code. You can bill this add-on code for every additional 20 square cm.
97602 CPT Code
Wound debridement may be reported with 97602 for the elimination of dead tissue with non-selective methods. This can be enzymatic agents or non-selective methods.
Billing Guidelines For The Wound Debridement CPT Codes
Usually you cannot charge for surgeries in addition, to E/M codes. When you perform and bill for a debridement the assessment of the wound before debridement the actual removal of damaged tissue and any post procedure instructions given to the patient on that treatment day are all included.
If the documentation shows that an E/M service provided on the day as a debridement is separately identifiable from and distinct from the debridement service(s) rendered Medicare will cover it if it is deemed “reasonable and necessary.”
According to the Centers for Medicare & Medicaid Services, the code used for debridement should account for factors such as the type and amount of tissue removed during surgery as characteristics like depth, size and other aspects of the wound.
When submitting a claim, for a procedure identified by CPT code 11044 it is advisable to include evidence indicating how deep the debridement was.
For instance, if a lesion has exposed bone but no bone was removed during the procedure you cannot bill using CPT code 11044.
Only report CPT 97598 in combination CPT code 97598 for the primary procedure.
Example 1
A 65-year-old man comes in with an incision, on his lower measuring about 10 square centimeters. The doctor will need to clean and remove the tissue from the wound a process known as debridement.
For this would debridement procedure the appropriate CPT code to use is 11042.
Example 2
There’s a patient who’s 45 years old and has a to treat wound on their leg, which measures around 35 square centimeters. Debridement, which involves removing tissue to promote healing and prevent infections would be beneficial in this case.
To bill for this wound debridement procedure, you can use CPT code 11043; “Debridement of skin and subcutaneous tissue each 20 centimeters or portion thereof.”
Example 3
An elderly gentleman in his eighties arrives at the emergency room, with a leg wound that covers approximately 60 square centimeters. The wound contains tissue and it will require extensive debridement.
Use CPT code 11043 for each set of skin and subcutaneous tissue that covers a 20 square centimeters or portion thereof beyond the initial 20 square centimeters (which falls under CPT code 11044). This applies specifically to the total of 40 centimeters being treated.
Sources
- https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=55818&ver=17
- https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/wound-care-coding-clarification.html
