Debridement basics:Coding and DocumentationAlejandro Perez, MD, FSVM, RPVIProvidence Heart and Vascular Institute, Vascular MedicineRegional Medical Director for Providence Wound Care and Hyperbaric Program

Columbia Wound Care ConsortiumQuarterly Symposium October 22, 2016

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Disclosures

None

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Objectives

• Understand debridement related terminology

• Understand requirements for documentation

What debridement type indicated?

What debridement type indicated?

Warning- Controversy Ahead

Debridement type

Advanced practitioner (MD, DO, NP, PA)Selective and Excisional

Nursingbased on hospital policy

Must defer to both CMS and LCD

Selective Debridements:Defined

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 A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION

Selective Debridements

CPT 97597/97598Removal devitalized tissue• One would use CPT 97597 to bill for

debridement of the first 20 cm² of aggregate wound size.

• Use CPT 97598 for any subsequent 20 cm² increments of debrided tissue.

Excisional Debridements

CPT 11042Debridement of wounds down to and including subcutaneous tissue for the first 20 cm² or lessCPT 11045For each additional 20 cm² increments or part thereof. Bill with 11042.

Excisional: muscle/fascia

CPT 11043Debridement of muscle and/or fascia (includes epidermis, dermis and subcutaneous tissue, if performed). first 20 cm2CPT 11046 for each additional 20 cm² or part thereof . Bill with 11043.

Excisional: bone

CPT 11044Debridement of bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 cm² or less.CPT 11047 for each additional 20 cm² or part thereof. Bill this code in conjunction with CPT 11044.

Debridement requirements

• CPT codes 11042-11043, 97597 and 97598 describe debridement of relatively localized areas with or without their contiguous underlying structures.

• These codes are appropriate for treatment of skin ulcers, circumscribed dermal infections, conditions affecting contiguous deeper structures, and debridement of ground-in dirt such as from road abrasions

Excisional Debridements - LCD

CPT codes 11042-11047 do not refer solely to ulcer size, but also to levels of actual tissue debridement levels (based on tissue type; e.g., partial skin, full thickness skin, subcutaneous tissue, etc.) of independent (non contiguous) skin and other deeper tissue structures.

All debridements- LCD

When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of wounds that are the same depth, but do not combine wounds from different depths.

Examples

If wound 5x2 cm. If selectively debride 50% and excisionally debride the same wound 50%. Then submit as excisional debridement for 10 sq cm.

S E E

Examples- multiple sites debrided

Add togetherAdd together

Additional precautions based on LCD

• “Once debridement is properly done repeat debridement is not expected for several days afterward….”

• No quantification of “several days”

Debridement for wound precludes

• Billing for Unnaboot or multilayer wrap on same leg

• Billing for total contact cast on same leg• Billing for E&M visit unless new non-

wound issue arises that is actively being managed (not deferred to PCP) or clinical worsening of wound requiring new management (typically infection)

Selective debridements

• CPT 97597 and 97598 may be used for the medically reasonable and necessary debridement with utilization consistent with this LCD and within scope of practice of the performing provider.

ICD-10 Codes (Be Specific!)

• For all ulcers need to be specific about location (ankle, heel, etc) with depth, and laterality

Summary

• Document what you do• Know when you need help