General Surgery Coding Alert

Any number of procedures, including debridement, blood vessel and nerve repair(s), lesion excision and others, may accompany wound repair (12001-13160). Knowing when these procedures are bundled and when they are separately reportable and how to report them properly will greatly improve claims' accuracy and reimbursement turnaround. Debridement Is Included, Usually Debridement (cleansing and removal of devitalized tissue) commonly accompanies wound repair at any level (simple, intermediate or complex). According to CPT instructions, wound repair includes debridement unless "gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure." Note: For more information on reporting primary wound repairs, see General Surgery Coding Alert, November 2002. For example, a motorcyclist involved in an accident suffers extensive lacerations of varying depth due to "road rash." Several of the wounds require repair/closure, but they also contain gross contamination (asphalt, dirt, etc.). And significant areas of tissue surrounding wounds on the leg and forearm require trimming. In this case, the wounds are primarily superficial and qualify as simple or, at best, intermediate repairs. But because the amount of cleansing and tissue removal greatly exceeds that which typically accompanies such repairs, the surgeon may report debridement separately. In a second example, a bicyclist has similar but less severe injuries. In this case, contamination of the wound is greater than that associated with simple repair, but not unusually extensive. Consequently, the surgeon may choose the intermediate repair codes (due to the contamination) but cannot report debridement separately. For extensive debridement of soft tissue or bone not associated with open fracture(s) and/or dislocation(s) (as in the first example above), choose the appropriate code from the 11040-11044 range, e.g., 11043, Debridement; skin, subcutaneous tissue, and muscle. For extensive debridement associated with open fracture(s) and/or dislocation(s) (e.g., in the first example above, the motorcyclist also has an open fracture of the tibia), select the appropriate code from the 11010-11012 range. When reporting wound repair and debridement codes together, you must observe two important guidelines, says Cindy McMahan, CPC, an independent coding consultant based in Albany, Wis. First, provide documentation to justify the separate debridement code(s). The attending surgeon should specifically note that the wound required extensive debridement and record the area and time involved, as well as the extent (i.e., depth superficial, full thickness, skin and muscle, etc.) of the procedure. Without this information, the coder cannot choose an appropriate code, and/or the payer will reject the debridement code(s) as bundled to wound repair. Second, append modifier -59 (Distinct procedural service) to the debridement code(s). The modifier tells the payer that the debridement is a separate and distinct procedure, beyond that usually associated with wound [...]