Podiatry Coding & Billing Alert

Puzzle out CPT^® and ICD-10 codes in this debridement scenario.

If your podiatrist sees patients who suffer from non-pressure chronic ulcers, you'll want to master the CPT^® guidelines for debridement and have a thorough grasp of what to look for in the medical documentation.

Read on to learn how to protect your podiatry practice's wound debridement reimbursement.

First, Understand CPT^® Debridement Guidelines

Debridement defined: When a podiatrist performs a debridement, he removes dead, damaged or infected tissue to facilitate natural healing of the patient's remaining healthy tissue.

You should report wound debridements, which includes codes 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less) through +11047 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)), by the depth of tissue the podiatrist removed and by the surface area of the wound, according to CPT^®.

You may report these codes for "injuries, infections, wounds and chronic ulcers," CPT^® adds.

Single wound: When the podiatrist performs debridement of a single wound, report the depth using the deepest level of tissue he removed.

Multiple wounds: When the podiatrist performs debridement of multiple wounds, sum the surface area of the wounds that are at the same depth, according to CPT^®. Do not combine sums from different depths.

Don't miss: For debridement of skin (epidermis and/or dermis only), report the following codes, which are considered "active wound care management," per CPT^®:

• 97597 (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 whirlpool, when performed and instruction(s) for ongoing care, per session; total wound(s) surface area; first 20 sq cm or less)
• +97598 (... each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)). Note: You should report +97598 in conjunction with 97597, according to CPT^®.

Walk Through This Scenario to Choose Correct Dx and CPT^® Codes

Coding scenario: The podiatrist sees the patient. Upon examining her feet, the podiatrist notes that the patient has a right midfoot non-pressure ulcer with necrosis of muscle. The podiatrist documents a diagnosis of a midfoot non-pressure ulcer.

ICD-10 solution: The diagnosis coding solution would be L97.413 (Non-pressure chronic ulcer of right heel and midfoot with necrosis of muscle).

Don't miss: The patient has necrosis of muscle, and necrosis refers to how healthy the wound is, according to Jordan Meyers, DPM, partner at Raleigh Foot and Ankle Center and consultant at Treace Medical Concepts, Inc. in Raleigh, North Carolina.

Necrosis is a sign that there is likely inadequate perfusion to the wound (vascular issue), Meyers says.

CPT^® component: The podiatrist prepped and anesthetized the same patient from the scenario above and performed prolonged cleansing of the patient's right midfoot ulcer involving muscle. The podiatrist used forceps and scissors to remove the damaged tissues and necrotic material from the skin and muscle layer, which involved skin, subcutaneous tissue, fascia, and muscle. The provider excised tissue from the wound until she saw healthy bleeding on the skin's edges. The provider then controlled the bleeding, applied an antibiotic, and dressed the wound. The size of the wound was 4.0 cm x 3.5 cm.

CPT^® solution: You would report 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less).

Mark Down These Documentation Details

As an example of details to be on the lookout for in debridement documentation, check out what CGS's local coverage determination (LCD) for Debridement Services (L34032) says the patient's medical record should include the following. Editor's note: This is not an exhaustive list of debridement documentation requirements. You should always be familiar with your particular payers' local coverage determinations (LCDs) because different LCDs may have specific requirements:

• An op note for the debridement service describing the anatomical location the podiatrist treated; the instruments he used; the anesthesia he used, if required; the type of tissue the podiatrist removed from the wound; the depth and area of the wound; and the immediate post procedure care and follow-up instructions.
• The wound's location, size, depth, and stage by description and/or a drawing or photo.
• A description of the tissue involvement, severity of tissue destruction, undermining or tunneling, necrosis, infection, or evidence of reduced circulation.
• Comorbid medical and mental conditions and all health factors that may influence the patient's ability to heal tissue.
• The initial treatment plan and the expected frequency and duration of the treatment and the patient's potential to heal.

This particular LCD also includes this point: "Photographic documentation of wounds either immediately before or immediately after debridement is recommended for prolonged or repetitive debridement services (especially those that exceed five extensive debridements per wound (CPT® code 11043 and/or 11044)).

In a recent McVey Podiatry Seminar, teacher Dawn R. Cloud CPC, CMSCS, CHCI, CPOM, business owner of First Choice Billing, LLC, in Maricopa, Arizona, emphasized the importance of photographic evidence by using an example from Michael G. Warshaw, DPM, CPC, CPODCS, COCS, CSFAC, CMSCS, certified medical coder and consultant: Dr. Warshaw has the patient sign and date a paper ruler. He then puts the ruler next to the wound and takes a picture of it. So, every time the patient comes in, the picture will include the patient's name, the date the picture was taken, and the size of the wound.

According to Dr. Warshaw, "Pictures can't lie," Cloud says. Taking the picture is the best way to tell what the wound is doing. This is something he always recommends you do.