General Surgery Coding Alert

Question: Recently, we received a denial for debridement of a decubitus ulcer, coded as 11040. We-ve never had problems with this in the past. Any suggestions? Arizona Subscriber Answer: Check your diagnosis. Since 2005, ICD-9 has required a fifth digit for decubitus ulcer diagnosis to specify location, as follows: 707.00 -- Decubitus ulcer, unspecified site 707.01 -- ...elbow 707.02 -- ... upper back 707.03 -- ... lower back 707.04 -- ...hip 707.05 -- ... buttock 707.06 -- ...ankle 707.07 -- ...heel 707.09 -- ... other site. Remember that "unspecified site" differs from "other site." You would bill the unspecified code if the doctor didn't dictate the site (you have no information). You would bill the "other site" code if the doctor treated a site somewhere like the calf, which doesn't have its own code. Example: The surgeon debrides partial-thickness skin on the hip for decubitus ulcer and full-thickness skin on the buttock for a second bed sore. You should report 11040 (Debridement; skin, partial thickness) with 707.04 (to identify the location as the hip) and 11041 (... skin, full thickness) with 707.05 (to identify the location as the buttock). Learn more: For complete information on CPT coding for decubitus ulcers, see "One Question Separates Ulcer Excision From Debridement," General Surgery Coding Alert, Vol. 10, No. 10, pages 75-76.