# Debridement Sacral wound



## KBean2018 (Oct 8, 2019)

Hello, I am trying to figure out the total cm. Would I only code 11043? Thank you in advance for any help.
Procedure(s):
DEBRIDEMENT SACRAL WOUND  Procedure Note
 Pre-op Diagnosis: Infected decubitus ulcer, stage IV (HCC) [L89.94, L08.9]
   Post-op Diagnosis: SAME

CPT Code: Procedures:
  * DEBRIDEMENT SACRAL WOUND, SKIN AND MUSCLE AND SOFT TISSUE.

ICD-10 : Post-Op Diagnosis Codes:
   * Infected decubitus ulcer, stage IV (HCC) [L89.94, L08.9]

Findings: The skin looks macerated directly in the midline, this is the upper sacrum and the lowermost extent is about 3 fingerbreadths from the anus. Cutting mode cautery excises this skin, there is bleeding at the edges to enter a stringy, purple fluid-filled area.  That is debrided bilaterally to bleeding, some fascia of the gluteus muscles removed bilaterally, some muscle is removed.  Once debrided to healthy tissue, there is soft filmy tissue overlying the palpable sacrum but not the level of the coccyx.  This area of palpable bone is about 3 cm longitudinally 2 cm bilaterally but bone itself is not exposed and the palpable bone is firm.  We then used 3 L of pulsevac, any bleeding points are controlled with cautery, and the bed is hemostatically packed firmly with about a foot of Betadine-soaked Kerlix and the remainder folded over as a dry dressing.  I had infiltrated, bilaterally, a total of 30 mL 0.5% Marcaine without epinephrine for postoperative pain control.  The longitudinal defect of skin opening 6 cm, bilaterally 4 cm, these 3 cm deep with minimal undermining below about 2 cm.

Description of Procedure: In the supine position with appropriate monitoring she received general anesthesia and then rolled to the padded right lateral decubitus position.  The bilateral gluteus and sacrum to the level of the anus prepped with Betadine and draped.  Cutting mode cautery excises the central natal cleft into a cavity, using Bonnie forceps, and retractors, any filmy tissue is debrided to healthy bleeding throughout except overlying the bone.  We will save that for another day if required at all.  Once hemostasis is secured after pulsevac, packed.  Dressings are applied, she is rolled supine, extubated and transported to PACU


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## thomas7331 (Oct 8, 2019)

The documentation is not very clear.  I would interpret the statement "_defect of skin opening 6 cm, bilaterally 4 cm_" to indicate that the wound is 6 cm vertically (up and down the spine).  Horizontally, I'm not sure if the provider means 4 cm across the entire wound, or 8 cm (4 cm to the left plus 4 cm to the right).  So depending on this, the wound size could be 24 sq cm or 48 sq cm.  I think you could safely code for the 24 sq cm (11043 and 11046 x 1), but it might be better to query the provider to get clarification so that you have an accurate wound size.


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## KBean2018 (Oct 8, 2019)

Ok. i agree. Thank you so much for your feedback Thomas Field's


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## Ccdgea08 (Mar 9, 2020)

Medicare is denying 11046 for frequency.  Should I be billing it as 11043 11046 11046 or 11043 11046 x2.  Please any info would be appreciated.  Thanks.


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## jojokat (Mar 19, 2020)

When we have this same scenario, we bill 11043 +11046 qty 2 and in the appropriate field that corresponds to box 19 on the HCFA form, we specify total sqcm treated.  Ex: debrided 48sqcm on Sacrum.  We do not generally have any issues with payment.


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## thomas7331 (Mar 19, 2020)

Ccdgea08 said:


> Medicare is denying 11046 for frequency.  Should I be billing it as 11043 11046 11046 or 11043 11046 x2.  Please any info would be appreciated.  Thanks.



A denial due to frequency would usually be due to an LCD guideline that limits how many debridement services may be performed within a given period of time.  Typically, debridement of skin ulcers would only be considered medically necessary once per week for a period of 3 months, for example, but you may be able to appeal if your documentation supports that meets the requirements.  For example, it was a debridement of a different or new wound that was under a separate course of treatment.  I'd recommend checking your Medicare contractor's LCDs on debridement and taking it from there.


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