ED Coding and Reimbursement Alert

Question: A patient presented to the ED with canine mastication to the thigh. The physician debrided the devitalized tissue. Would the 11040-11044 codes be appropriate or should I report a code from the 97597-97602 series?

Montana Subscriber Answer: In this case, the 11040 code set is probably more appropriate. Depending on the depth of the wound, you would choose one of the following:
  11040 - Debridement; skin, partial thickness
  11041 - ... skin, full thickness
  11042 - ... skin, and subcutaneous tissue
  11043 - ... skin, subcutaneous tissue, and muscle
  11044 - ... skin, subcutaneous tissue, muscle, and bone. The 97597 (Removal of devitalized tissue from wound[s], selective debridement, without anesthesia, with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may include use of a whirlpool, per session ...) code set is more likely to represent work done in an ongoing wound care clinic setting rather than the emergency department. The techniques mentioned in these codes - such as a high-pressure water jet and the requirement for ongoing care (indicated by mention of a whirlpool treatment) - describe approaches not commonly performed in the ED.

 - Reader Questions and You Be The Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc. in Stoneham, Mass.