2011 CPT Changes
Daniel J Nagle, MD
Debridement - Open Fracture
Editorial revisions were made to the codes used to report debridement of an open fracture and/or open dislocation (11010-11012). The work RVUs and global periods for these three codes will not change for 2011.
11010 Debridement including removal of foreign material associated with at the site of an open fracture(s) and/or dislocation(s) (eg, excision debridement); skin and subcutaneous tissues
11011 skin, subcutaneous tissue, muscle fascia, and muscle
11012 skin, subcutaneous tissue, muscle fascia, muscle, and bone
Debridement (NOT open fracture)
The New Year will bring significant changes to reporting debridement not related to an open fracture or open dislocation. First, codes 11040 and 11041 (skin debridement) will be deleted and replaced by revised active wound care management codes 97597 and 97598. Second, the other debridement codes (subcutaneous, muscle/fascia, and bone) have been split into debridement of the first 20 sq cm (or less) and each additional 20 sq cm (or part thereof). The last major change occurred with the global period. The primary codes 11042, 11043, and 11044 will have a global period of 000 beginning in 2011. Follow-up hospital or office visits will no longer be included in the payment for these codes and will need to be reported separately – if no other procedure with a 10 or 90 day global was performed at the same time. The global period for the add-on codes will of course be ZZZ. These add-on codes can be reported in multiples, as necessary, and are a welcome change for surgeons who treat trauma victims who require debridement of many wounds.
11040 Debridement; skin, partial thickness (DELETED)
11041 Debridement; skin, full thickness (DELETED)
For debridement of skin, (ie, epidermis and/or dermis), see 97597, 97598.
11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
+11045
Each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) (note that this code number is out of sequence)
11043
Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
+11046
Each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) (note that this code number is out of sequence)
11044
Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
+11047
Each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) (note that this code number is out of sequence)
97597
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
+97598
Each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
Wound debridements (11042-11047) are reported by depth of tissue that is removed and by surface area of the wound. These services may be reported for injuries, infections, wounds, and chronic ulcers. When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths.
DEBRIDEMENT CODING EXAMPLE:
A young woman who was rollerblading fell and suffered injuries to the palmar surface of both hands and the anterior aspect of her right leg. No bones were fractured. Her left hand required extensive debridement of devitalized and contaminated tissue in a 4 cm x 4 cm area of epidermis. Her right hand required debridement through the subcutaneous tissue of a 3 cm x 10 cm area. Her right leg required debridement down to and including contaminated bone of a 5 cm x 10 cm area.
Procedures to Report:
Left Hand:
97597-59 Debridement of skin (epidermis/dermis), first 20 sq cm
Right Hand:
11042-59 Debridement, subcutaneous tissue, first 20 sq cm
+11045-59 Debridement, subcutaneous tissue, additional 20 sq cm, or part thereof
Right Leg:
11044 Debridement, bone, first 20 sq cm
+11047 Debridement, bone, additional 20 sq cm, or part thereof
+11047-59 Debridement, bone, additional 20 sq cm, or part thereof
The procedure on the left hand involves debridement of skin ONLY (ie, epidermis and/or dermis). Revised codes 97597 and 97598 are used to report debridement of the first 20 sq cm of skin and each additional 20 sq cm of skin, respectively, 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. Since only 16 sq cm of skin required debridement of devitalized and contaminated skin, only code 97597 would be reported.
The procedure on the right hand involves debridement of a 30 sq cm area of subcutaneous tissue. Code 11042 would be reported for the first 20 sq cm and add-on code 11045 would be reported for the remaining 10 sq cm of 30 sq cm total wound surface.
The procedure on the right leg includes debridement of bone. Code 11044 would be reported for the first 20 sq cm and add-on code 11047 would be reported twice for the second 20 sq cm and the remaining 10 sq cm of 50 sq cm total wound surface. Note that codes 11010-11012 (debridement, open fracture) would not be correct because the bone was contaminated but not fractured.
The work of code 97597 is included in the work of 11042 and 11044 and the work of 11042 is included in the work of 11044. Therefore, it is important to append modifier 59 (distinct procedural service) to the two lesser primary procedures (97597 and 11042) to indicate that the debridement on the right and left hands are separate wounds at separate operative sites and (most importantly) at separate depths.
Additional notes:
CPT coding instructions do not indicate that modifier 59 be appended to add-on codes. However, some payers may require appending modifier 59 to the second and subsequent add-on codes to indicate that these add-on codes are not simply inappropriate duplicate billing. In addition, modifier 51 is not appended to any of these codes. Many payers (including Medicare) recommend against reporting modifier 51 on claims. Their processing system has hard-coded logic to append the modifier to the correct procedure codes submitted on the same claim. You should follow the rules of your payers.
Incision and Drainage
Codes 20000 and 20005 were non-specific for incision of a "superficial" or "deep/complicated" soft tissue abscess. For 2011, code 20000 will be deleted and replaced by code 10060 and 10061. Code 20005 will be revised. There will be no change to the work RVU or global period for code 20005.
20000 Incision of soft tissue abscess (eg, secondary to osteomyelitis); superficial (DELETED)
(For incision and drainage procedures, cutaneous/subcutaneous, see 10060, 10061)
20005
Incision and drainage of soft tissue abscess, subfascial (ie, involves the soft tissue below the deep fascia) (eg, secondary to osteomyelitis); deep or complicated