Fix This Ulcer Debridement Claim
Question: We submitted a claim for a wound debridement that was denied. The provider documented that the patient had a stage 3 pressure ulcer of the right heel measuring 3 cm x 4 cm with necrotic bone exposed. The physician removed dermis, epidermis, fat, muscle, and bone. We originally reported 11042, 11043, 11044, and L89.614. How can we correct the claim? Washington Subscriber Answer: Let’s start with the surgical debridement CPT® codes. According to the CPT® code book, “When performing debridement of a single wound, report depth using the deepest level of tissue removed.” This means that you’ll report a code that specifies debridement of bone since that is the deepest layer treated. In this case, you’ll report 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less) for debridement of the stage 3 pressure ulcer. Code 11044 includes muscle and fascia debridement, which is represented with 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less). Code 11044 also covers dermis and epidermis debridement, which fall under 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less). Next, turn to the ICD-10-CM code book. The initially reported diagnosis code, L89.614 (Pressure ulcer of right heel, stage 4), specifies a stage 4 pressure ulcer of the right heel, but the documentation shows a stage 3 pressure ulcer of the right heel. Correct the claim by changing the ICD-10-CM code to L89.613 (Pressure ulcer of right heel, stage 3). Mike Shaughnessy, BA, CPC, Production Editor, AAPC
