Understand What Services Are Included in Debridement Procedure
Question: A patient comes in for a wound debridement appointment every week. According to their medical record, the provider suspected that the wound was infected. The provider performed a 11042, took a culture to ascertain whether an infection was present, and prescribed an antibiotic. Since the provider went beyond the normal debridement services, can I bill for a separate evaluation and management (E/M) service? Georgia Subscriber Answer: According to AAPC’s Codify, CPT® code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less) can be reported for “injuries, infections, wounds, and chronic ulcers.” Since the guideline specifies that this service code includes situations involving infections, this situation probably wouldn’t qualify as a separate E/M service. If the infection affected a different wound or location, then it could possibly count as a separately identifiable service and could be billed as a separate or additional E/M code. In this situation, think of the infection and treatment as a complication of the original wound and part of the same 11042 service. Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
