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When to Code Debridement As a Separate Procedure

When to Code Debridement As a Separate Procedure


When to Code Debridement as a Separate Procedure

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ADVANCE Columnist

Even though the current procedural terminology (CPT) code manual includes guidelines for assigning debridement as a separate procedure, many coders still question when this is appropriate. As stated in the CPT manual, debridement may be reported separately when one of the following occurs: prolonged cleansing, appreciable amounts of devitalized tissue are removed and/or debridement is carried out without immediate primary closure.

For debridement of soft tissue and/or bone, the CPT code manual directs users to codes 11040-11044. For extensive debridement of subcutaneous tissue, muscle fascia, muscle, and/or bone associated with open fracture(s) and/or dislocation(s), review codes 11010-11012 (below).

The 1997 CPT code manual includes the three new debridement codes mentioned above (11010-11012). As shown below, they describe debridement associated with open fracture(s) and/or dislocations.

CPT Procedure Codes
11010 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin and subcutaneous tissues

11011 skin, subcutaneous tissue, muscle fascia and muscle

11012 skin, subcutaneous tissue, muscle fascia, muscle and bone

These codes are primarily used when irrigation and debridement procedures are performed on open fractures, open tendon and nerve injuries, and closed fractures.

Wound repair also may include repair of multiple layers of skin, subcutaneous tissue and bone. Both open and closed wounds may need to have debridement performed to ensure an adequate repair of the wounds. Codes 11010-11012 represent more extensive services than those represented by 11040-11044. The following case studies depict examples of this.

Case Study #1
The patient presented with a degloving injury of the left lower extremity combined with a lateral malleolar fracture. The injury occurred 48 hours ago. The procedure included extensive debridement of the degloving injury and repair of the closed lateral malleolar fracture.

With the patient under general anesthesia in the supine position, the leg was prepped in the standard meticulous fashion. On initial examination, the wound demonstrates clean granulation anteriorly. What appeared to be a dry eschar covered about three-quarters of the wound.

Upon removing the eschar, it was apparent that there was necrosis under the surface that had to be debrided. This was debrided through the subcutaneous fat down to the peroneal musculature and the peroneal tendon distally. There was no sign of infection clinically. The tendons all appeared viable. The wound was irrigated after extensive debridement of skin, subcutaneous tissue and some muscle fascia. A splint was applied for stabilization of the fracture and the degloving injury.

Code Assignments
11011 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia and muscle

Coding Rationale
The extensive debridement of the degloving injury associated with the malleolar fracture represents the type of case for which the new debridement codes (11011-11012) were created. Debridement codes 11040-11044 do not adequately describe debridement of more extensive types of injuries (i.e., degloving injuries, soft tissue devitalization and extensive foreign-material contamination), and should therefore only be used to report a lesser type of debridement case.

Code 11011 is the only code assigned to this case. It is not necessary to assign a separate code for the splint application since it is included in the debridement procedure.

Case Study #2
The patient presented with wound necrosis of the skin, subcutaneous tissue and fascia of an anterior abdominal wound. The physician performed debridement of the abdominal wound with deep, delayed primary closure.

With the patient under adequate anesthesia, a wound debridement was carried out removing additional hypertrophic granulation tissue.

Dissection was carried down to the anterior fascia where the skin and subcutaneous tissue were separated from the anterior fascia on each side for a distance of 3 to 4 cm back from the central wound edge. This was done over an extended length of incision, probably 10 to 12 cm.

That having been done, careful hemostasis was obtained. Deep subcutaneous fascia and Scarpa's fascia were closed with running 2-0 Vicryl. Subcuticular closure was achieved with 3-0 Vicryl. A dry sterile dressing was applied. The patient tolerated the operation and anesthesia well.

Code Assignments
11043 Debridement; skin, subcutaneous tissue and muscle

12034 Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm

Coding Rationale
As reported by the physician, the debridement of the abdominal wound was extended through the skin and subcutaneous tissue into the muscle fascia. CPT code 11043 describes the debridement of the abdominal wound, and 12034 describes the layer closure of the wound. Assign both of these codes.

When assigning debridement codes, it is important to remember that the physician's documentation must support the code function.

* About the author: Peggy M. Hapner is a senior health care consultant and outpatient coding expert at Medical Learning, Inc. (MedLearn). She develops publications, performs coding assessments and conducts on-site training in diverse coding topics.


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