Primary Care Coding Alert

Question: Is it acceptable to code 11042 and 10120 together? If so, do I need to include a modifier of some sort?

West Virginia Subscriber

Answer: Correct Coding Initiative (CCI) edits do not bundle 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) with 10120 (Incision and removal of foreign body, subcutaneous tissues; simple), and nothing in CPT^® otherwise prevents reporting both services when they are distinct. The services represented by the codes, however, may overlap to the extent that debridement involves removal of foreign material and dead or damaged tissue, especially in a wound.

Go through your physician’s documentation again before finalizing the claim. If the foreign body was in a different anatomic area than the debridement, feel free to report both services with confidence. In that situation, you may want to append modifier 59 (Distinct procedural service) to one of the two codes to emphasize the distinct nature of the services, even though no CCI edits are in play. If the foreign body was in the same anatomical area and was readily available to remove when he performed the debridement, your best choice might be to report only 11042, since, by common definition, “debridement” includes removal of foreign material as well as dead or damaged tissue.