# 11045 denails with multiple units



## ashishkokare (Jul 27, 2015)

hi can anyone tell me how to bill 11045 with 16 units i  received deanails for 11045


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## mitchellde (Jul 28, 2015)

11045 is an add on code.  You need a 11042 code first, also that is a huge amount of surface.  That is a total of 320 square centimeters.  Which in inches is an area about 8x8inches.  Check your math carefully.


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## TWinsor (Jul 28, 2015)

we also have been getting denials for 11045 when we bill more than 3 or 4 units.  We have had to appeal with documentation.  I agree with Debra check your math as that is a really large area. 

HTH


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## espressoguy (Jul 28, 2015)

First off, 16 units would be 320 square centimeters (16x20). Add another 20 square centimeters for the initial 11042 for a total for 340 square centimeters.

CMS considers any more than 4 units total (or it might be 5, can't remember off the top of my head), to be medically unlikely. As TWinsor said this would need to be appealed with documentation.

I have been coding for the Wound Care Clinic at my hospital for almost 4 years and I can only recall seeing a wound this big once or twice.

Edited to add: I just thought of this, since the debridement codes are cumulative, if the person had multiple wounds of the same depth, total wound size might not be that unusual.


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## mitchellde (Jul 28, 2015)

Sorry somehow I got an extra 2 in there.  But if you do the conversion to inches it is still enormous as an area or even as a collection of areas.  I would be curious as to the procedure note and the diagnosis.


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## ashishkokare (Jul 30, 2015)

*11045 with more units*

actually we received superbill with 11045 code with more than 4 units we received 11042
11045 coded with 7,11,16 units so what is the solution for more than 4 units for 11045.. please guide 

Regards

Ashish S Kokare-CPC


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## mitchellde (Jul 30, 2015)

ashishkokare said:


> actually we received superbill with 11045 code with more than 4 units we received 11042
> 11045 coded with 7,11,16 units so what is the solution for more than 4 units for 11045.. please guide
> 
> Regards
> ...



I would need to read the procedure note to determine the codes.  You should not be coding based only on a superbill.


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## espressoguy (Jul 30, 2015)

I agree with Debra (except when it comes to math  ). Do not code from the superbill. Read the procedure note. Make sure the note indicates that this was a sharp, excisional debridement down to and including subcutaneous tissue. There also needs to be an indication as to type of instrument was used. Do the math. The note needs to indicate the size of the wound. Calculate the size of the wound (length times width). The first 20 sq cm is 11042 and each subsequent 20 sq cm is 1 unit of 11045

At any rate, assuming these are the correct codes, my first answer stands. Appeal with documentation and this should be paid.


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