Q&A: Reporting and billing CPT codes for ulcer debridement on multiple sites

Q: A patient receives treatment for two ulcers, one on his foot and one on his hip. The physician performs a subcutaneous debridement to treat the foot ulcer and a muscle debridement to treat the hip ulcer. How would this be reported?

A: You would report the higher-level code without a modifier because you don’t want a [payment] reduction to occur on this code. You would report the muscle debridement first, since it’s higher in terms of the service rendered, work completed, and cost.

There are two separate ulcers, so you would report modifier -XS (distinct procedural service performed on a separate organ/structure) to identify a separate site.

The coding or billing specialist would report the following CPT codes:

• 11043, debridement, muscle and/or fascia, first 20 sq. cm or less
• 11042-XS, debridement, subcutaneous tissue, first 20 sq. cm or less with modifier to identify distinct procedural service on a separate site 

If you don’t use the -X{EPSU} modifiers in your facility, you could also bill 11043 and 11042-59. Modifier -59 specifies a distinct procedural service.

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, “Pressure Ulcer Coding: Strategies for ICD-10-CM Coding Accuracy.” 

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