Q&A: CPT coding for wound debridement with bilateral compression dressings

Q: A patient presents with ulcers on her legs and feet. The physician performs wound debridement on her right foot, then applies multilayer compression dressings to both legs. In this case, would it be appropriate to code for both the compression dressing and the debridement performed on the right side? How should this be coded?

A: In this scenario, the debridement on the right foot and both multilayer wraps are chargeable. This is only true if the leg ulcers are separate from the foot ulcer that was debrided.

The following CPT codes would be reported:

• 11042, debridement, subcutaneous tissue (includes epidermis and dermis, if performed), first 20 sq. cm or less
• 29581-50-XS, application of multilayer compression system, leg (below knee), including ankle and foot; with modifiers to note bilateral procedure and separate structure (service is distinct because it was performed on a separate organ/structure)

Modifier -XS should be appended to the code 29581 to indicate that the multilayer wraps were used on separate sites. Appending modifier -50 ensures that the facility will get reimbursed for both legs. You also want to make sure that the charge for the 29581 is increased by double so your payment is not reduced. 

If your hospital is not currently using the -X{EPSU} modifiers, then you can replace the -XS modifier with modifier -59 (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, “Clean Up Wound Care Coding, Reduce Audit Risk: 2018 Coding and Guideline Updates.”

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.

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