General Surgery Coding Alert

Question: I am coding four different debridement sites on the foot but they are all at different areas. I am planning to use 11043 times three and 11040 once. I intend to add modifier 51 to all the codes except the first 11043. Is this correct coding, or is modifier 59 more appropriate?

Tennessee Subscriber

Answer: You are correct about the procedures codes you'll report: 11043 (Debridement; skin, subcutaneous tissue, and muscle) and 11040 (Debridement; skin, partial thickness). However, you should not be using modifier 51 (Multiple procedures). Instead, you should be using modifier 59 (Distinct procedural service). Here is what your coding should look like:

• 11043

• 11043-59

• 11043-59

• 11040-59.

The reasoning: You should use modifier 59 to identify procedures that are distinctly separate from any other procedure your surgeon provides on the same date. Specifically, CPT -- backed by guidelines found in Chapter 1 of the Correct Coding Initiative (CCI) -- instructs that you may append modifier 59 to your claim when a physician sees a patient during a different session, treats a different site or organ system, makes a separate incision/excision, tends to a different lesion, or treats a separate injury.

Think of it this way: Modifier 51 is an informational modifier for use on the second, third, etc., surgical procedure performed on the same day. Modifier 59 overrides bundles between procedure codes, set up by CCI.