Q&A: CPT coding for wound debridement based on the depth of the removal
Q: What criteria should coders be looking for in provider documentation for wound debridement to report the correct CPT code?
A: Outpatient facilities perform three basic types of wound debridement:
- Excisional: Surgical removal of tissue at the wound base until viable tissue is removed
- Selective: Surgical removal of non-viable tissue
- Non-selective: Non-surgical removal of non-viable tissue
Each type has its own code or series of codes in the CPT Manual.
Typically, providers use selective and non-selective debridement to treat shallow wounds because these procedures involve removing dead tissue. They generally use excisional debridement to treat deeper wounds affecting structures beneath the skin’s surface.
Excisional debridement codes are divided by the level of tissue removed and the size of the wound debrided. If the physician removes only subcutaneous tissue, coders would report CPT code 11042 (debridement, subcutaneous tissue; first 20 sq. cm or less) for the first 20 sq. cm and add-on code 11045 (debridement, subcutaneous tissue; each additional 20 sq. cm, or part thereof) for each additional 20 sq. cm debrided.
For excisional debridement of muscle or fascia, coders would report CPT code 11043 (debridement, muscle or fascia [includes epidermis, dermis, and subcutaneous tissue, if performed]; first 20 sq. cm or less) for the first 20 sq. cm and add-on code 11046 (debridement, muscle or fascia; each additional 20 sq. cm, or part thereof) for each additional 20 sq. cm debrided.
If the physician debrides a wound down to the bone, report code 11044 for the first 20 sq. cm and add-on code 11047 (debridement, bone; each additional 20 sq. cm, or part thereof) for each additional 20 sq. cm debrided.
Providers see ulcers day after day and sometimes forget to provide crucial information about the depth of these injuries. In some instances, a picture of the wound prior to surgical intervention is worth a thousand words— it can give the coder a good idea as to the depth and severity of the injury.
Editor’s note: Gloria Miller, CPC, CPMA, CPPM, vice president of reimbursement services at Comprehensive Healthcare Solutions Inc., in Seattle, answered this question during the HCPro webinar, “Combat Outpatient Wound Care Coding and Documentation Challenges in 2019.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.