When reporting debridementspartial thickness, full thickness, skin and subcutaneous tissuehow do you know which codes to use? asks Kay Spading, RHIT, coding specialist at Marengo Memorial Hospital in Marengo, Iowa.
The answer lies mainly in getting ED physicians to provide adequate documentation of the debridement and decontamination procedures performed, says Betty Ann Price, RN, BSN, CCS-P, president of Professional Reimbursement and Coding Strategies, a consulting firm based in Palmetto, Fla.
The physician documentation should clearly indicate the extent of the injury by illustration and/or detailed description, she states. It is virtually impossible to presume the depth and layers of debrided tissue, for example, without specific indication by the physician.
When emergency department (ED) physicians repair deep lacerations, complex fractures and other open wounds, they often must cut away skin and subcutaneous tissue that has been so badly damaged it cannot be repaired. This process, called debridement, allows the still healthy skin and/or tissue to be closed, letting the wound heal. Physicians and ED staff may also spend a lot of time cleaning a dirty wound or removing contaminating materials (i.e., glass shards, splinters, other foreign objects) from the wound prior to closure.
Physicians can report these services, in addition to the wound repair, with the CPT Excision-Debridement codes (11000*-11044) in the Surgery/Integumentary System section of CPT.
Note: The wound repair is reported with codes in the range 12001-13160 in the Repair (Closure) heading in the same section. The excision-debridement codes are not used to report dermabrasions, nail debridements or treatment of burns. Those procedures have separate codes.
Debridement Included in Wound Repair Code
A limited amount of debridement and cleansing is included in the code for the wound repair, adds Price.
According to CPT 2000, debridement is considered a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately from primary closure. So, how should the coder know when the debridement is separately reportable?
Again, the documentation should be clear, says Price. Some examples of debridement would include the documentation indicating, large amounts of devitalized tissue dissected from the area of injury and grossly contaminated wound jet irrigated extensively with 500 cc of saline with excellent results.
Coders tip: It is also important to note that, when assigning the code for wound repair, single-layer wounds that require extensive debridement will usually warrant an intermediate repair code and, in some cases, a complex repair code, Price adds.
Codes 11000* and 11001
