WhitneyH_24046
Well-known member
Hey CCO team, Do you all have any great resources you would recommend for learning wound care coding? Thanks so much.
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Resolved Wound Care Resources
- Thread starter WhitneyH_24046
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Lori
Well-known member
CCO has this free tool
Wound Care Measurement & Repair Grid
Wound Care Measurement & Repair Grid This free Wound Measurement & Repair Grid serves as the perfect 'cheatsheet' for medical coders. If you're trying to figure out the correct medical codes for
https://www.cco.us/wound-care-measurement-repair-grid/
Billing & Coding Guidelines for Wound Care
https://downloads.cms.gov/medicare-..._attachments/34587_21/L34587_GSURG051_BCG.pdf
Diagnosis Code for Debridement- Medical Coding
Excisional debridement is the sharp removal of tissue at the wound margin or at the wound base until viable tissue is removed. Coders report excisional debridement codes (CPT codes 11042-11047) based on the deepest layer of viable tissue removed. 11042—11047 Use these codes when the only procedure performed is wound debridement. Use these codes for foot ulcers,
Complete documentation for excisional debridement requires five elements, including:
i. A description of the procedure as “excisional”
ii. A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette)
iii. A description of the tissue removed (e.g., necrotic, devitalized or non-viable)
iv. The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.)
v. The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue, muscle, or bone)
Documentation guidelines for CPT® codes 11042—11047
• Reported by depth of tissue that is removed and surface area of wound.
• Per CPT® Assistant, may be reported for injuries, infections and chronic ulcers.
• For a single wound report the depth using the deepest level of tissue removed (multiple depths, one wound=one code). That is, some parts of a single wound may be at the level of the subcutaneous tissue, but one section of the wound reaches the level of the fascia. Report the code for debridement of the fascia.
• For multiple wounds of the same depth, add the surface area of these wounds. For example, a patient has a wound at the subcutaneous level of the left buttock and the right heel. Since these wounds are at the same level, and debridement codes are not selected by anatomic site, add together the surface area of both wounds to select the code.
• For multiple wounds of different depths, report each separately at the deepest level for each.
A physician can debride a wound to remove dead, damaged, or infected tissue so the remaining healthy tissue can better heal. Coders need to look for specific information in the documentation of wound debridement.
Types of debridement
Debridement’s are classified as:
• Excisional
• Selective
• Non-selective
Each type has its own code or series of codes in CPT.
Excisional debridement is the sharp removal of tissue at the wound margin or at the wound base until viable tissue is removed. Coders report excisional debridement codes (CPT codes 11042-11047) based on the deepest layer of viable tissue removed. The codes for excisional debridement are divided by the level of tissue removed and the size of the wound debrided. If the physician removes only subcutaneous tissue, coders will report CPT code 11042 for the first 20 sq cm and 11045 for each additional 20 sq cm. So if the physician documents removal of 65 sq cm of subcutaneous tissue, ¬coders would report 11042 and 11045x3. For debridement of muscle or fascia, coders ¬report 11043 for the first 20 sq cm and 11046 for every ¬additional 20 sq cm. If the physician debrides a wound down to the bone, report 11044 for the first 20 sq cm and 11047 for each additional 20 sq cm. Note that the ¬add-on codes for additional sq cm do not directly follow the codes for the first 20 sq cm..
Selective debridement (CPT codes 97597-97598) is the removal of nonviable tissue. Unlike excisional debridement, the physician removes no living tissue in a selective debridement.
Non-selective debridement (CPT code 97602) is the gradual removal of nonviable tissue and is generally not performed by a physician, Rosdeutscher says.
Total area removed When coding multiple debridement’s on the same level, such as three subcutaneous debridement’s, coders should total the surface area debrided and select the appropriate codes. For example, a physician documents a 26 sq cm debridement to the muscle of the upper right arm, a 15 sq cm debridement to the muscle of the right shoulder, and a 16 sq cm debridement to the muscle of the lower right arm. The coder would add all three areas together for a total of 57 sq cm and report 11043 for the first 20 sq cm and 11046x2 for the remaining 37 sq cm. If the physician documents debridement’s to ¬different levels at the same anatomical site, report only the deepest debridement. If the physician documents different levels of debridement at different anatomical sites, coders should report both debridement’s and append modifier -59 (distinct procedural service) to the shallower debridement, he adds. For example, the physician documents a 14 sq cm debridement to the bone on the patient's left leg and a 35 sq cm subcutaneous debridement of the patient's left arm. Coders would report 11044 for the left leg debridement and 11043-59 and 11046-59 for the left arm. Remember as well that coding is based on the surface area after the debridement. ¬Coders should look for documentation of the type of tissue removed and whether the wound is larger. This will help them decide whether to bill excisional codes or removal of nonviable tissue codes. For an excisional debridement, the post-debridement wound size should always be larger because the physician is removing living tissue.
Selective debridement
Coders cannot report an excisional debridement if the debridement does not include at least one of the following:
• Bleeding tissue
• Removal of viable tissue
• Increasing wound size by width, length, or depth
In cases that don't meet any of the above criteria, ¬coders may assign an E/M visit level, removal of devitalized tissue, or a non-selective debridement. The removal of devitalized tissue is called selective debridement or active wound management.. Coders should only report these codes once per visit, ¬regardless of how many wounds are debrided. These codes are only used when a provider removes nonviable tissue, and coders should not see documentation of bleeding (which indicates living tissue). Documentation for selective debridement must include the following elements:
• Location and characteristic of lesion
• Depth (should be minimal)
• Type of tissue removed (nonviable)
• Instrument used (can be sharp)
• Patient's tolerance
• Dressings applied and treatment plan
•
Be sure to check with your local FI/MAC for any ¬local coverage determinations or specific documentation requirements for wound care.
Documenting excisional debridement
Need a quick checklist for excisional wound debridement?
:1. Medical decision to perform procedure
2. Location and characteristics of wound
3. Type of tissue removed (eschar, fibrin, bone, etc.)
4. Depth of procedure
5. Amount of bleeding and how it was stopped
6. Instrument used and size of instrument
7. Patient tolerance and pain control
8. Dressing applied and treatment follow-up
9. Pre- and post-debridement measurements Remember that if the physician performs a subcutaneous, muscle, or bone debridement, the wound measurements should be larger post-debridement.
Wound debridement codes (not associated with fractures) are reported with CPT codes 11042-11047. Wound debridement’s are reported by the depth of tissue that is removed and the surface area of the wound. These services may be reported for injuries, infections, wounds, and chronic ulcers. When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of the wounds that are at the same depth, but do not combine sums from different depths. These procedures require the use of forceps, scissors, scalpel, or tissue nippers. The codes are used when the wound is intended to heal by secondary intention.
Coding Tips: Do not report codes 11042-11047 in conjunction with codes 97597-97602 for the same wound.
Wound Care Measurement & Repair Grid
Wound Care Measurement & Repair Grid This free Wound Measurement & Repair Grid serves as the perfect 'cheatsheet' for medical coders. If you're trying to figure out the correct medical codes for
https://www.cco.us/wound-care-measurement-repair-grid/
Billing & Coding Guidelines for Wound Care
https://downloads.cms.gov/medicare-..._attachments/34587_21/L34587_GSURG051_BCG.pdf
Diagnosis Code for Debridement- Medical Coding
Excisional debridement is the sharp removal of tissue at the wound margin or at the wound base until viable tissue is removed. Coders report excisional debridement codes (CPT codes 11042-11047) based on the deepest layer of viable tissue removed. 11042—11047 Use these codes when the only procedure performed is wound debridement. Use these codes for foot ulcers,
Complete documentation for excisional debridement requires five elements, including:
i. A description of the procedure as “excisional”
ii. A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette)
iii. A description of the tissue removed (e.g., necrotic, devitalized or non-viable)
iv. The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.)
v. The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue, muscle, or bone)
Documentation guidelines for CPT® codes 11042—11047
• Reported by depth of tissue that is removed and surface area of wound.
• Per CPT® Assistant, may be reported for injuries, infections and chronic ulcers.
• For a single wound report the depth using the deepest level of tissue removed (multiple depths, one wound=one code). That is, some parts of a single wound may be at the level of the subcutaneous tissue, but one section of the wound reaches the level of the fascia. Report the code for debridement of the fascia.
• For multiple wounds of the same depth, add the surface area of these wounds. For example, a patient has a wound at the subcutaneous level of the left buttock and the right heel. Since these wounds are at the same level, and debridement codes are not selected by anatomic site, add together the surface area of both wounds to select the code.
• For multiple wounds of different depths, report each separately at the deepest level for each.
A physician can debride a wound to remove dead, damaged, or infected tissue so the remaining healthy tissue can better heal. Coders need to look for specific information in the documentation of wound debridement.
Types of debridement
Debridement’s are classified as:
• Excisional
• Selective
• Non-selective
Each type has its own code or series of codes in CPT.
Excisional debridement is the sharp removal of tissue at the wound margin or at the wound base until viable tissue is removed. Coders report excisional debridement codes (CPT codes 11042-11047) based on the deepest layer of viable tissue removed. The codes for excisional debridement are divided by the level of tissue removed and the size of the wound debrided. If the physician removes only subcutaneous tissue, coders will report CPT code 11042 for the first 20 sq cm and 11045 for each additional 20 sq cm. So if the physician documents removal of 65 sq cm of subcutaneous tissue, ¬coders would report 11042 and 11045x3. For debridement of muscle or fascia, coders ¬report 11043 for the first 20 sq cm and 11046 for every ¬additional 20 sq cm. If the physician debrides a wound down to the bone, report 11044 for the first 20 sq cm and 11047 for each additional 20 sq cm. Note that the ¬add-on codes for additional sq cm do not directly follow the codes for the first 20 sq cm..
Selective debridement (CPT codes 97597-97598) is the removal of nonviable tissue. Unlike excisional debridement, the physician removes no living tissue in a selective debridement.
Non-selective debridement (CPT code 97602) is the gradual removal of nonviable tissue and is generally not performed by a physician, Rosdeutscher says.
Total area removed When coding multiple debridement’s on the same level, such as three subcutaneous debridement’s, coders should total the surface area debrided and select the appropriate codes. For example, a physician documents a 26 sq cm debridement to the muscle of the upper right arm, a 15 sq cm debridement to the muscle of the right shoulder, and a 16 sq cm debridement to the muscle of the lower right arm. The coder would add all three areas together for a total of 57 sq cm and report 11043 for the first 20 sq cm and 11046x2 for the remaining 37 sq cm. If the physician documents debridement’s to ¬different levels at the same anatomical site, report only the deepest debridement. If the physician documents different levels of debridement at different anatomical sites, coders should report both debridement’s and append modifier -59 (distinct procedural service) to the shallower debridement, he adds. For example, the physician documents a 14 sq cm debridement to the bone on the patient's left leg and a 35 sq cm subcutaneous debridement of the patient's left arm. Coders would report 11044 for the left leg debridement and 11043-59 and 11046-59 for the left arm. Remember as well that coding is based on the surface area after the debridement. ¬Coders should look for documentation of the type of tissue removed and whether the wound is larger. This will help them decide whether to bill excisional codes or removal of nonviable tissue codes. For an excisional debridement, the post-debridement wound size should always be larger because the physician is removing living tissue.
Selective debridement
Coders cannot report an excisional debridement if the debridement does not include at least one of the following:
• Bleeding tissue
• Removal of viable tissue
• Increasing wound size by width, length, or depth
In cases that don't meet any of the above criteria, ¬coders may assign an E/M visit level, removal of devitalized tissue, or a non-selective debridement. The removal of devitalized tissue is called selective debridement or active wound management.. Coders should only report these codes once per visit, ¬regardless of how many wounds are debrided. These codes are only used when a provider removes nonviable tissue, and coders should not see documentation of bleeding (which indicates living tissue). Documentation for selective debridement must include the following elements:
• Location and characteristic of lesion
• Depth (should be minimal)
• Type of tissue removed (nonviable)
• Instrument used (can be sharp)
• Patient's tolerance
• Dressings applied and treatment plan
•
Be sure to check with your local FI/MAC for any ¬local coverage determinations or specific documentation requirements for wound care.
Documenting excisional debridement
Need a quick checklist for excisional wound debridement?
:1. Medical decision to perform procedure
2. Location and characteristics of wound
3. Type of tissue removed (eschar, fibrin, bone, etc.)
4. Depth of procedure
5. Amount of bleeding and how it was stopped
6. Instrument used and size of instrument
7. Patient tolerance and pain control
8. Dressing applied and treatment follow-up
9. Pre- and post-debridement measurements Remember that if the physician performs a subcutaneous, muscle, or bone debridement, the wound measurements should be larger post-debridement.
Wound debridement codes (not associated with fractures) are reported with CPT codes 11042-11047. Wound debridement’s are reported by the depth of tissue that is removed and the surface area of the wound. These services may be reported for injuries, infections, wounds, and chronic ulcers. When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of the wounds that are at the same depth, but do not combine sums from different depths. These procedures require the use of forceps, scissors, scalpel, or tissue nippers. The codes are used when the wound is intended to heal by secondary intention.
Coding Tips: Do not report codes 11042-11047 in conjunction with codes 97597-97602 for the same wound.
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WhitneyH_24046
Well-known member
Thanks so much Lori and Jesus for all the resources. Very helpful. I never thought I would be learning wound care, but I am.
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