General Surgery Coding Alert

Failed attempts may lead to negative pressure therapy.

When your surgeon treats integumentary wounds, you have several code families to choose from that seem to overlap in confusing ways.

Let our experts show you how to choose between debridement codes and various active wound care codes to accurately bill for your surgeons’ work.

Spotlight Secondary Intention

Surgeons have lots of ways to repair wounds and lots of types of wounds to repair. But the focus of this discussion is wounds in the epidermis, dermis, and subcutaneous tissue that the surgeon treats to heal a wound by secondary intention.

Glossary: Healing by secondary intention means that the surgeon leaves the wound open. Instead of closing the wound using a method such as sutures or glue, the clinician performs procedures such as removing foreign matter or dead tissue to improve the body’s own healing.

The codes: 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 may perform some of these services for wounds such as injuries, infections, venous or arterial insufficiency ulcers, diabetic foot ulcers, or wounds that don’t heal properly,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, California.

Don’t use these codes for wounds deeper than subcutaneous tissue or for wounds that have their own codes, such as burns (16000-16035), pressure ulcers (15920- 15999), surgical preparation (15002-+15005), nail debridement (11720-11721), or dermabrasion (15780-15783).

Focus Code Selection on Procedure Differences

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 scalpel and scissors. This is typically a onetime treatment to prepare the wound to heal.

Note: Other debridement codes describe a similar process for deeper wounds (11043 and +11046 for muscle and/or fascia; 11044 and +11047 for bone).

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: If the surgeon debrides wounds of the same depth from different anatomic sites in the same session, you should add the surface areas together, according to Catherine Brink, BS, CPC, CMM, president of Healthcare Resource Management in Spring Lake, New Jersey.

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 the course of treatment.

Like 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.

Skin only: Don’t use debridement codes for wounds shallower than subcutaneous tissue. CPT^® instruction following code 11042 states, “For debridement of skin (ie, epidermis and/or dermis only), see 97597, +97598.”

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.