ED Coding and Reimbursement Alert

In many cases, debridement performed in the emergency department will be included in whichever wound repair codes are assigned. However, there are instances when debridement may be reimbursed separately. To successfully report these codes, ED coders must understand when it is appropriate and what level of documentation is required.
 
Cindy McMahan, CPC, an independent coding consultant based in Albany, Wisc., notes that CPT is specific about when debridement is included in a closure code. It can be reported separately only when the wound is grossly contaminated and prolonged cleansing is required, she says. An example is a barnyard laceration with contamination. In order to justify the use of these codes in addition to wound repair codes (12001*-13160), the physicians notes must clearly state that the wound was significantly contaminated and should quantify the amount of saline or other substance used to cleanse the wound. McMahan adds that, when circumstances allow both types of codes to be assigned, modifier -59 (Distinct procedural service) should be appended to the debridement code. This informs the payer that the ED physician recognizes that debridement is generally bundled into wound repair, but that clinical circumstances require the separate service.
 
Notes in the CPT manual add that debridement codes may also be used independently of repair codes when large amounts of devitalized or contaminated tissue are removed, and when debridement is performed without immediate primary repair of a wound.
Debridement Without Wound Repair  
For example, a debridement code should be reported when an ED physician cleanses gravel, shards of glass or other particulate matter from road rash sustained in a motorcycle accident. When a patient comes in after a motorcycle accident, it is very likely that the physician will need to remove debris from the injury, very possibly without wound repair, says Betty Ann Price, RN, BSN, CCS-P, president of Professional Reimbursement and Coding Strategies, a consulting firm based in Palmetto, Fla. In this case, the debridement code would be used.
 
Choosing a code will depend upon the documentation in the medical record, she adds. This is where assigning these codes becomes difficult, she says. The physician must provide detail about the type of tissue and the layers that were involved for coders to determine the proper code.
 
When reporting this type of debridement, CPT offers five codes:

  11040 Debridement; skin, partial thickness (involves the epidermis and/or superficial epithelial layer of skin)

  11041 skin, full thickness (involves both the epidermis and dermis containing the blood vessels, nerves, nerve endings, glands and hair follicles)

  11042 skin, and subcutaneous tissue

  11043 skin, subcutaneous tissue, and muscle

  11044 skin, subcutaneous tissue, muscle, and bone.  
Unfortunately, coders are often unable to report the service, because the ED physicians notes dont provide enough information, Price says. [...]