General Surgery Coding Alert

Highlight the differences between the wound and procedure to select the right code.

When your surgeon treats integumentary wounds, you have several codes to choose from that may be confusing or appear to overlap.

Keep reading to discover the best approach for selecting the appropriate codes for debridement and active wound care. This will ensure that you can bill accurately for the services provided by your surgeons.

Understand Secondary Intention

Surgeons possess a variety of techniques to mend injuries and a wide range of injury types to address. However, this conversation primarily centers around injuries located in the epidermis, dermis, and subcutaneous tissue that the surgeon manages with the aim of promoting secondary intention healing.

Healing by secondary intention means that the surgeon leaves the wound open. The surgeon performs debridement and wound management procedures, which involve the removal of foreign objects or necrotic tissue to enhance the body’s natural healing processes, rather than using sutures or glue to close the wound.

Surgeons may use the following procedures to help wounds heal by secondary intention:

• 11042 and +11045 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); … sq cm …)
• 97597-+97598 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; … sq cm …)
• 97605-99606 (Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area … 50 square centimeters)
• 97607-97608 (Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) surface area … 50 square centimeters)

Clinicians have the expertise to provide a range of services for various types of wounds. These services can be beneficial for wounds caused by injuries, infections, ulcers resulting from venous or arterial insufficiency, diabetic foot ulcers, or wounds that exhibit delayed healing.

Don’t use these codes for wounds deeper than the subcutaneous layer or for wounds that have their own distinct codes, such as burns, pressure ulcers, surgical preparation, nail debridement, or dermabrasion.

Concentrate on Procedure Differences When Choosing Code

Debridement codes 11042 and +11045 describe the process of invasively removing infected or      devitalized tissue, and possibly other foreign matter, from a wound. The surgeon might use forceps and/or sharp instruments such as a scalpel and scissors. This is typically a singular treatment to prepare the wound to heal and would not be repeated.

For debridement of wound(s) of a given depth, you report the code(s) based on the total wound surface area treated. The first 20 sq cm or less counts toward the first code in each pair, with the add-on code for each additional 20 sq cm or part thereof.

Different sites: When the surgeon performs wound debridement on multiple anatomical sites during the same session, you need to calculate the total surface area by adding up the individual surface areas.

Active wound care: Although codes 97597-+97598 also describe removing dead or infected tissue from a wound and may involve debridement tools such as forceps and sharps, active wound care involves other services. The clinician typically uses a high-pressure water jet and topical applications at the wound site and may also use a whirlpool. Additionally, active wound care therapy includes wound assessment and care instructions, and the clinician typically repeats the procedure multiple times during treatment.

Similar to the debridement codes, you should assign active wound care codes based on the wound surface area in increments of 20 sq cm or part thereof. According to Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager at MRO in Philadelphia, “The active wound codes are to be used for treatment of the epidermis and dermis. Full-thickness wounds are treated with the 11042 and +11045 codes. Also, ensure the note includes the total square centimeters treated.”

Remember: Don’t use debridement codes for wounds shallower than subcutaneous tissue.

Negative pressure: Instead of debridement or high-pressure water jet, clinicians may treat wounds using negative pressure therapy, also called vacuum-assisted drainage collection (VAC or VAD) (97605-97608). The procedures involve sealing the wound with a foam covering and inserting a tube under the foam. The clinician then uses a vacuum-assisted device to remove and collect devitalized tissue and fluids, effectively cleansing the wound. The procedure stimulates healing of the wound surface by reducing edema, improving oxygenation, and placing mechanical stress on the wound; thus, increasing cellular proliferation, blood vessel growth, and formation of granular tissue. Like the other active wound care codes, VAC services include wound assessment and instructions for ongoing care.

Details: CPT^® divides VAC into two code families based on whether the procedure uses durable medical equipment (DME, 97605, 97606) or disposable equipment (97607, 97608). You’ll also use wound surface area in your code selection for VAC services, choosing 97605 or 97607 for wounds less than 50 sq cm, and 97606 or 97608 for wounds greater than 50 sq cm.

Review Specifics of Wound to Choose Best Option

Although you should be able to choose the correct procedure code based on the surgeon’s description of the service, understanding clues about the wound condition will help you zero in on the correct codes.

Chronic vs. acute: According to CPT^® Assistant (October 2016, Volume 26: Issue 10), “wound debridement is intended for debriding acute wounds of devitalized tissue, while active wound care management is intended for cleansing and promoting healing of chronic wounds.”

Medicare does not have a National Coverage Determination (NCD) for debridement and active wound therapy, but guidelines are available for specific Local Coverage Determinations (LCDs) at www.cms.gov/medicare-coverage-database.

Many LCDs include the same guidance, and you can use that information to help you choose the correct code.

Recurrent: When the patient’s condition requires recurrent wound debridements, you should typically bill 97597/+97598, not debridement codes 11042-+11047.

Like CPT^®’s list of alternate codes for specific wound types, Medicare contractor guidance indicates that you should not bill debridement and active wound care codes for specific treatments such as burns or nail debridements. “Also keep in mind the code use is going to be based on the depth of debridement rather than frequency. Sometimes, conditions do require multiple full-thickness debridements,” says Brame Joy.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC