ED Coding and Reimbursement Alert

Question:

Oregon Subscriber

Physicians typically use the debridement codes (11000-11001, Debridement of extensive eczematous or infected skin; ... or 11004-11005, Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; ...) for debridement by any method.

Without question these codes most closely describe wound debridement by sharp curettement. You should only report wound care management codes such as 97605-97606 (Negative pressure wound therapy [e.g., vacuum assisted drainage collection], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session; ...) for a therapeutic service that involves more than simple wound debridement.

These codes require "direct (one-on-one) patient contact" to debride the site and "promote healing," according to CPT instruction. As the definition indicates, the encounter involves topical applications and patient care instruction in addition to removing devitalized tissue.

AMA weighs in: The June 2005 CPT Assistant states, "Codes in the active wound care management series provide a mechanism for reporting interventions associated with active wound care as performed by licensed nonphysician professionals. For wound debridement performed by physicians, see codes 11040-11044." In other words, active wound care management codes describe wound therapy, not just surgical debridement.