For example: Bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer. Coding Rationale The physician excised a malignant lesion from the patient's lower leg followed by closure with a split-thickness graft. Subsequent debridement is often more superficial and best described by CPT codes 97597 or 97598 rather than 11043 or 11044. CPT considers debridement a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.. A determination of the initial treatment plan to include the expected frequency and duration of the skilled treatment and the potential to heal. 1 Instructions for enabling "JavaScript" can be found here. Non-excisional debridement (e.g., 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) is described as nonsurgical because it does not involve cutting away or excising devitalized tissue. Replacement material, graft size, multiple wounds all these factors and more [], Dont miss pregnancy impact. Local infiltration, metacarpal/digital block or topical anesthesia are included in the reimbursement for debridement services and are not separately payable. Q4102 . CPT Procedure Codes. authorized with an express license from the American Hospital Association. The views and/or positions presented in the material do not necessarily represent the views of the AHA. Copyright © 2022, the American Hospital Association, Chicago, Illinois. Be sure that the documentation supports that the wound area covered by the skin substitute was 20 sq. Guidance on these codes is available in the Bill type and Revenue code sections. To report these codes, the surgeons documentation should demonstrate work such as removing nonviable tissue and/or releasing a scar contracture. 2022 HCPro, a brand of Simplify Compliance. Select Debridement Codes by Depth. *This response is based on the best information available as of 4/11/19. If a physician uses a curette to debride slough on the surface of the wound is that classified as subcutaneous or non-surgical? Application of Bioengineered Skin Substitutes and Skin Grafting is performed on ulcers that are free of . 0000007521 00000 n My plastic surgeon debrided an open burn wound that was 45 sq cm then placed a split thickness skin graft over the wound. 11011 skin, subcutaneous tissue, muscle fascia and muscle. These codes are used for wound debridement but only when you are debriding an open wound with no intention of closing it; you expect the wound to heal by secondary intention. Debridement is the removal of dead (necrotic) or infected skin tissue to help a wound heal. When subcutaneous tissue is debrided from a 16 s. cm dehisced abdominal wound and a 10 sq cm thigh wound, report 11042 for the first 20 sq cm and 11045 for the second 6 sq cm. Skin Substitute, Oasis wound Matrix, per square centimeter In most instances Revenue Codes are purely advisory. (application of skin substitute graft to, for example, leg or ankle). /| 43 32 Skin replacement surgery consists of two basic steps: surgical preparation of the recipient site and placement of the graft with fixation. See CPT coding guidance for proper use of the coding. Left axillary artery to left femoral artery bypass with an 8 mm PTFE graft INDICATIONS: . 0000010490 00000 n Code 86.22, Excisional debridement, was defined as the "surgical removal or cutting away of devitalized tissue, necrosis, or slough," which could be performed in the operating room, emergency room, or at the patient's bedside. However, please note that once a group is collapsed, the browser Find function will not find codes in that group. Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. *4 Use CPT code 15340-15341 or CPT code 15360-15366 for the surgical preparation or creation of recipient site for the tissue skin graft. If the provider is unable to use photographs for documentation purposes, the medical record should contain sufficient detail to determine the extent of the wound and the result of the treatment. iii. Do not report 11042 -11047 in conjunction with 97597-97602 for the . Based on what I have read in the Official Guidelines for Coding and Reporting and Coding Clinic for ICD-9-CM, I believe that I should report two separate codes.Otherwise, the graft code would have an includes note indicating the debridement is inherent in the code. HLN>bE+hAi .xiJ2D4>"A_6N@f("nChK!`=x;c` DIS!Sf8_c^x)$ When subcutaneous tissue is debrided from a 16 s. cm dehisced abdominal wound and a 10 sq cm thigh wound, report 11042 for the first 20 sq cm and 11045 for the second 6 sq cm. When other reconstructive procedure(s) (skin graft, myocutaneous flap, vessel graft . Codes 15002-15005 apply specifically to describe the work of "preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy," according to CPT guidelines. Debridement of diabetic foot ulcers more frequently than once every seven (7) days, for a period longer than three (3) months may not be reasonable and necessary. jQuery(function() { _initLayerSlider( '#layerslider_57_r6v94to757da', {createdWith: '6.8.2', sliderVersion: '6.9.2', allowFullscreen: true, pauseOnHover: 'enabled', skin: 'v6', sliderFadeInDuration: 350, useSrcset: true, skinsPath: 'https://karenzupko.com/wp-content/plugins/LayerSlider/assets/static/layerslider/skins/', performanceMode: true}); }); KarenZupko & Associates, Inc. 2023 | All Rights Reserved. To report these codes, the surgeons documentation should demonstrate work such as removing nonviable tissue and/or releasing a scar contracture. Autologous skin grafts are those that the surgeon harvests from another healthy part of the patients own body, and you would use different codes for those graft procedures. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential LGXt5q]$]0"$T ?@Z"&&g2~caPa;SS:Sk \SA?3U'VXAHKJ66 R f`p/2XNd@T1 The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. cm. 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC If you miss the separate skin preparation step, youll sacrifice pay your surgeon deserves. The treatment plan for a patient who requires frequent repeated debridement should be reevaluated, to ensure that pressure reduction and infection control have been adequately addressed. The procedure is essential for wounds that aren . These unique codes are classified as per the anatomic site (general and specific body areas) and size (wounds with a total surface area less than 100 sq. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 100 up to 200 sq Remember that the debridement codes, 11042-11047, are reported when you debride an open wound that will stay open to heal by secondary intention. 2021 Evaluation and Management Codes: Is a History Required? If the documentation supports that 20 sq. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. rW`n":Q5g%_7:j)j9."QFGH(2My"hqt}%%l}]KkWmNhlI,(PjqK9%.v#|3^ya%h'e'e2iB@iFOk|q)7 If.ug q&QP;jNy>9cW=aB=je>m3/dDQMA;2VJ0E5&Qj2[iG"^l+E. 1 G/r f VY;fuC{r@,>^Q k1[1Q3#V^DJ;;j!E"&~'/;{1M, ~ B ^(\%@%t m+?Rh@yK You can collapse such groups by clicking on the group header to make navigation easier. Answer: 2. That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. Skin Lesion Excision Wait for Pathology? Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. Youre right about the skin graft code(s). cm of skin substitute application (15271). Otherwise, the graft code would have an includes note indicating the debridement is inherent in the code. This code is based on a wound size (singular or aggregate size; after cleansing, prepping, and/or debriding) minimally of 100 sq cm*. Neither the United States Government nor its employees represent that use of such information, product, or processes This Agreement will terminate upon notice if you violate its terms. We are looking for thought leaders to contribute content to AAPCs Knowledge Center. The objective of the procedure is to . All rights reserved. Instructions for enabling "JavaScript" can be found here. As you can see, procedure code 86.69 (other skin graft to other sites) includes the debridement and closure of the amputation site via split-thickness skin graft. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. Medicaid and the State Children's Health Insurance Programs, contracts with certain organizations to assist in the administration accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the 0000002443 00000 n That means you should select the appropriate HCPCS Level II code such as Q4101 (Apligraf, per square centimeter) or C1763 (Connective tissue, non-human (includes synthetic)) for the graft material. Whether the surgeon performs both steps at a single encounter or delays grafting for a later time, report the surgical preparation using codes in the range 15002-+15005 (Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contractures ). Article document IDs begin with the letter "A" (e.g., A12345). CMS and its products and services are not endorsed by the AHA or any of its affiliates. Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. 1 Your MCD session is currently set to expire in 5 minutes due to inactivity. qe<>O &j'>-3c\BMAi`/@SPPkS u6X \[bkjqkXdV41+ahqg& _p,d4ueQ@Ha s0O The second code in each set (+15003 and +15005) are add-on codes that you should report for defect area beyond the initial size (for each additional 100 sq cm or 1 percent of body area or part thereof). 0000011160 00000 n appropriate codes to use when performing a non-surgical application of a skin substitute. A description of the procedure as excisional Answer: No. An official website of the United States government. trailer <<1D25FBD66AB6418699B8EC89A49470A5>]/Prev 196840>> startxref 0 %%EOF 74 0 obj <>stream Service: The work described by these codes involves preparing a clean, viable wound surface for graft placement to heal by primary intention (not secondary intention). Each pair of codes identifies the size of the defect created by the surgical preparation, with the first code (15002 or 15004) describing the first 100 sq cm for adults and children aged 10 and up, or 1 percent of body surface area for children under 10 years of age, including infants. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. H|Wd5W5Re'c X!XFk4K|?>_/]%zWCBJ7 .`u}}`JWJz=^o\z9e~BT AT9 vqdYkh%BprY-.%V)["[n . I96w4Ak1;*8LMZI;Oe1\s &$W2DQY#"E"2$*85lm"HIl]JW)"4#F3^6F8?1HtaG]xuA*D::!83P|MnKC*{:?qk,nlG,d=atI'0 I2nC For instance, Versajet debridement is considered to be nonsurgical, mechanical debridement because it does not involve cutting away or excising devitalized tissue. o Similar code pairs based on area: 15275 and +15276; 15277 and +15278 Can I report 11042 (debridement skin and subcutaneous tissue, first 20 sq cm) and +11045 (each additional 20 sq cm) for the debridement in addition to the split thickness skin graft code? Report these procedures, when they represent covered, reasonable and necessary services, using the CPT or HCPCS code that most closely describes the service rendered. v. The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue, muscle, or bone). You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. You, your employees and agents are authorized to use CPT only as agreed upon with the AMA internally within your organization within the United States for the sole use by yourself, employees and agents. To code the excision, look in the index for the term Lesion, then Skin. KarenZupko & Associates, Inc. 2023 | All Rights Reserved. Continuation of treatment plan with ongoing evidence of the effectiveness of that plan, including diminishing area and depth of the ulceration, resolution of surrounding erythema and /or wound exudates, decreasing symptomatology, and overall assessment of wound status (such as stable, improved, worsening, etc). This note should describe the anatomical location treated, the instruments used, anesthesia used if required, the type of tissue removed from the wound, the depth and area of the wound and the immediate post procedure care and follow-up instructions. Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). culture and sensitivity), osteomyelitis (e.g. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. The AMA does not directly or indirectly practice medicine or dispense medical services. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. For example, debridement of two ulcers on the foot to the level of subcutaneous tissue, total area of 6 sq cm should be billed as CPT code 11042 with unit of service of "1". Thank you. Terms: Primary intention means that the edges of the wound or graft are closed to allow them to grow together, while secondary intention refers to allowing an open wound to heal from the base up by building new tissue. 0000017002 00000 n Addition to Skin Graft Codes. and monitoring is occurring. Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. However, we do not recommend the 11042 - 11047 codes. Contractors may specify Bill Types to help providers identify those Bill Types typically Applications are available at the American Dental Association web site. Supplies such as A6453 (Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard) are included in the skin application charge. iC>:D~c~V*H0"Q%L]5CB Applicable FARS\DFARS Restrictions Apply to Government Use. Complete absence of all Bill Types indicates End User License Agreement: Coding Skin Procedures in the Office Setting Written and Presented by Susan Ward, CPC, CPC-H, CPC-I, CPCD, CEMC, CPRC . Note that debridement of the skin that is preparatory to further surgery, such as reduction of fracture, should not be coded as a separate procedure. If all four wounds were debrided on the same day, apply modifier 59 Distinct procedural service with either 11042 or 11044, as appropriate. apply equally to all claims. You can still separately code for deep debridement that includes muscle and bone, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington, using a code such as 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq. The views and/or positions +etUfqVW7]?5P .kJXp. 5. application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) An operative note or procedure note for the debridement service. endstream endobj startxref Biological implants 0000006208 00000 n and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only cm and All rights reserved, Debridement of the skin that is preparatory to further surgery such as reduction of fracture, etc., should not be coded as a separate procedure., The surgeon debrided the necrotic tissue surrounding the amputation site, harvested skin from the patient's thigh and closed the wound with a split thickness skin graft. 11042 - Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less + 11045 - each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Examples of the inappropriate use of these codes are ulcers, furuncles, and localized skin infections. Would also adding Mod 22 help, and for which one 11042 or 11043? For patients with chronic wounds being treated in an outpatient setting, services beyond the fifth surgical debridement, CPT code 11043, 11046 and/or 11044, 11047, per patient, per year, per wound may require a medical review of records demonstrating the medical reasonableness and necessity. 15004 and +15005 for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits 0000017393 00000 n To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (Application of skin substitute graft ). You will see two additional references: benign and malignant. 0000018702 00000 n The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. 1279 0 obj <>/Filter/FlateDecode/ID[<8B4464A13AA9C745B5A6304A9784D76D>]/Index[1253 57]/Info 1252 0 R/Length 97/Prev 314542/Root 1254 0 R/Size 1310/Type/XRef/W[1 2 1]>>stream Like the site preparation codes, CPT distinguishes these codes by anatomic site and wound surface area, as follows: Procedures involving the wrist and/or ankle are reported with codes that include arm or leg in the descriptor. You're right about the skin graft code (s). Code 86.69 may be assigned twice, if desired, to show the repair of the leg ulcer.. Supplies such as A6453 (Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard) are included in the skin application charge. U.+"x/J>DcB If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. Incision and debridement, right knee Exchange arthroplasty liner of right total knee arthroplasty OPERATIVE NOTE: . A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. K;7@J3"(>6&/~!.]wWV~- *h"BQ"H" 5=QHpI8$ {Lz Based on what I have read in the Official Guidelines for Coding and Reporting and Coding Clinic for ICD-9-CM, I believe that I should report two separate codes. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. CMS and its products and services are This question was answered by Denise Williams, COC, senior vice president of the revenue integrity division and compliance auditor at Revant Solutions in Trussville, Alabama. The surgeon may choose to leave the wound open in anticipation that healthy tissue will grow over the ulcer site. Skin substitute graft application code selection is based on defect site location and size. Another option is to use the Download button at the top right of the document view pages (for certain document types). Please reference the CPT descriptions for application of skin substitutes codes (Attachment C). CPT codes 97597 and 97598 are categorized by CMS as sometimes therapy services. reasonable efforts to provide accurate coding information, this information should not be construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. cm of the total 85.25 sq. "JavaScript" disabled. recommending their use. without the written consent of the AHA. End Users do not act for or on behalf of the CMS. 11012 skin, subcutaneous tissue, muscle fascia, muscle and bone. Tip 2: Identify Type of Skin Substitute Graft That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. Tech & Innovation in Healthcare eNewsletter, Excision of Benign or Malignant Skin Lesion, Reporting Debridement Requires Documented Area and Depth, Both Depth and Area Matter when Reporting Debridement, Meet Documentation Criteria for Excisional Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed) 11043, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed) 11044. hb```b``Qg`e`y @16.5&Gsf cQ"b8)l82+q {5lJ,lhn7: YZGA 3*l910eX,_ ,*KodXD78^mc0[dzMBt However, we do not recommend the 11042 11047 codes. The page could not be loaded. Autologous skin grafts are those that the surgeon harvests from another healthy part of the patients own body, and you would use different codes for those graft procedures. Not exactly. Sign up to get the latest information about your choice of CMS topics in your inbox. If the documentation supports that 20 sq. He is an alumnus of York College of Pennsylvania and Clemson University. Rather, it is removal of devitalized tissue, necrosis, and slough by other methods, including: Examples of non-excisional debridement are pulsed lavage, mechanical lavage, mechanical irrigation, high-pressure irrigation, etc. Im looking at getting 11042 (debridement) and the skin graft codes precertified. Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. 0000016096 00000 n These unique codes are classified as per the anatomic site (general and specific body. CPT is a trademark of the American Medical Association (AMA). Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. 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)). 0000001292 00000 n 0000006836 00000 n 0000020105 00000 n Secondary Payor Doesnt Recognize Consultations. The patient's comorbid medical and mental condition, and all health factors that may influence the patient's ability to heal tissue, such as, but not limited to the following: mental status, mobility, infection, tissue oxygenation, chronic pressure, arterial insufficiency/small vessel ischemia, venous stasis, edema, type of dressing, chronic illness such as diabetes mellitus, uremia, COPD, malnutrition, CHF, anemia, iron deficiency, and immune deficiency disorders. You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Article - Billing and Coding: Debridement Services (A56617). The following products may be billed with CPT codes 15430-15431 . Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. Debridement services are now defined by body surface area of the debrided tissue and not by individual ulcers or wounds. Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. 0000030507 00000 n The Medicare program provides limited benefits for outpatient prescription drugs. Include simple debridement: Skin replacement grafts include simple debridement of granulation tissue or recent avulsion. cm). Auto- is different: If you see the term autograft or tissue cultured autograft, then you are dealing with the harvest and/or application of an autologous skin graft. Services exceeding this intensity and duration of treatment will be considered not medically necessary. RyfJwE@~:_t4lGY@iYTSBd(m6 DZk0XGxmpP+pF+ff,rBQ*A-E;qkdKom`5!0>?|;!Qb5(Hj QPiX)=Zc4cgQ+*lri59? 1253 0 obj <> endobj You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. You need to master the different graft options and know how to find the information in the surgeons note, because CPT includes different code sets for each type of graft. 0000000936 00000 n If your session expires, you will lose all items in your basket and any active searches. Tip 1: Capture Site Preparation Note: This question can be found in the billing and claims category on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. and Full Thickness Skin Grafts Code range for STSG -15100 (Trunk, arms and legs) -15120 (Face, scalp, eyelids, mouth, neck, ears . 0000008214 00000 n Draft articles are articles written in support of a Proposed LCD. CPT codes 11000 and 11001 are not appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion. If there is not enough clarity, then a query would be indicated. A description of the tissue removed (e.g., necrotic, devitalized or non-viable) presented in the material do not necessarily represent the views of the AHA.