Anesthesia Coding Alert
Choose 01120 Over 00630 for Sacral Ulcer Debridement
Question: We have raised a question in our office regarding a debridement of a sacral ulcer to the bone with no closure using code 11044 (Debridement, bone [includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed]; first 20 sq cm or less). The ASA Crosswalk refers us to anesthesia code 01120, but information with 00630 includes the following comments: “RVG comment: Includes procedures on sacrum” and “RVG Comment: Code 00630 describes anesthesia for open procedures in the lumbar/sacral region.”
Our debate is whether 00630 or 01120 is a better choice for a debridement of a sacral ulcer (please keep in mind this is not an excision of a sacral ulcer). Thank you for your help.
South Dakota Subscriber
Answer: The correct anesthesia code is 01120 (Anesthesia for procedures on bony pelvis).
Rationale: First, 00630 (Anesthesia for procedures in lumbar region; not otherwise specified) is listed under the heading Spine and Spinal Cord, but the procedure you are describing debrides skin, muscle and bone. It does not involve the spinal cord, so 00630 isn’t an accurate choice. Second, even though this is not an “excision” of a sacral ulcer, it is similar in work. The sacral ulcer excision codes all cross to 00300 (Anesthesia for all procedures on the integumentary system, muscles and nerves of head, neck, and posterior trunk, not otherwise specified) or 01120, depending on the depth of the procedure. Code 00630 is used for procedures that are more in depth and a higher risk. It would not be appropriate for a sacral ulcer debridement.
Terminology: Remember that to debride means the provider is removing dead, contaminated, or adherent tissue and/or foreign material. To debride a wound is to remove all materials that may promote infection and impede healing. This may be done by enzymes (as with proteolytic enzymes), mechanical methods (as in a whirlpool), or sharp debridement (using instruments).
An excision, by contrast, represents surgical removal, as in excision of a tumor. The term “excision” implies at least partial, if not complete, removal.
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