Part B Insider (Multispecialty) Coding Alert

Diabetes note: You should use these codes when your physician treats a skin ulcer.

For example: A patient with uncontrolled type II diabetes presents with an ulcer on his lower leg. The physician debrides the wound through the subcutaneous tissue and applies a dressing.

For this scenario, you would code 11042 for the debridement. The dressing application is included in the debridement, so you may not bill for that service separately.

Debridement don't: For many Medicare carriers, there are specific services that you may not bill as debridement. For example, Cigna's debridement policy states that reporting 11040-11044 "is not appropriate for the following services: washing bacterial or fungal debris from lesions, paring or cutting of corns or calluses, incision and drainage of abscess including paronychia, trimming or debridement of nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement."

3. Dive Into Ulcer Coding

When reporting diabetic  ulcer debridement to carriers, make sure the diagnosis code is appropriate for the procedure, advises Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh.

For example: The diabetic patient from the previous example is suffering from a neuropathic ulcer on his lower leg.

You should code for diabetic ulcers using the 707.xx code series for chronic skin ulcers. Select 707.1 for a non-decubitus ulcer of the lower limb, and then choose the appropriate fifth digit according to the ulcer's location. In this case, you would choose 707.12 (...ulcer of calf). According to Medicare carrier HGSA, 707.12 is a covered diagnosis for CPT code 11042.

Tip: When coding ulcers, remember that the current coding system does not allow you to differentiate between a neuropathic ulcer and a neuroiscemic ulcer, notes Odom. It's an ulcer, regardless of what caused it, he says.

Correct order matters: Incorrectly sequencing diabetes and ulcer diagnosis codes is a common wound debridement coding error, says Renee Collington, CPC, of the department of surgery vascular division at UPMC Presbyterian-Shadyside in Pittsburgh.

Coders often list the diabetes diagnosis code (250.xx) first, followed by the ulcer code, such as 707.12. You should always report the ulcer code first and the diabetes code second, says Collington. Carriers want your primary diagnosis code to reflect the acute condition your physician treated during the visit. 

Example: In the case of the diabetes patient discussed above, you would code the ulcer (707.12) as the primary diagnosis, and then report the patient's diabetic neuropathy with 250.62 (Diabetes mellitus, diabetes with neurological manifestations; type II or unspecified type, uncontrolled). The fifth digit "2" indicates the patient suffers from type II, uncontrolled diabetes.

Take note: You only indicate the site of a wound with the 707 series diagnosis codes, but wound size and depth are also important for documentation. If your physician fails to document all three pieces of information in the patient's medical record, he may make choosing the correct level debridement code difficult for you, Hvizdash cautions.