Debridement is a procedure that is performed by physicians in many different specialties. There are a number of different debridement codes in the CPT book, but today, we will focus on CPT codes 11042-11047 which are some of the most commonly reported codes. While these codes have been around for a long time, there are still many questions about how to use them properly. I have a few key questions I ask myself when reviewing any debridement procedure to help me land on the correct codes.
Question #1: What is the diagnosis?
While this may feel like an odd place to start when trying to determine a procedure code, determining the diagnosis first is important because there are unique CPT codes available for debridement for specific conditions. For example, debridement of an open fracture is reported with CPT codes 11010-11012 and debridement of a partial thickness burn is reported with CPT codes 16020-16030. Once you’ve identified your diagnosis, you can search “debridement, _____” in your CPT book or coding software to see if a unique set of codes exists for debridement related to that condition. For the remainder of today’s article, we will focus on debridement reported with codes 11042-11047 which are what I call “catch all” codes which do not require a specific diagnosis, but being aware that there are other debridement codes to consider depending on your diagnosis is important.
Question #2: What is the deepest layer of tissue removed during the debridement? For each wound/area debrided, identify the deepest layer of tissue removed in terms of skin, subcutaneous, fascia, muscle, or bone.
Coding Tip: If only the skin is debrided, look at codes in the Medicine section of CPT (e.g., 97597-97598). If a layer of tissue deeper than the skin is debrided, CPT codes 11042-11047 can be utilized.
Notice that in the CPT descriptions in range 11042-11047, the debridement of a specific layer of tissue also includes the debridement of the more superficial layers above it. For example, CPT code 11042 is reported for debridement of the subcutaneous tissue, but the code description clarifies that this code would also include debridement of the skin layers (epidermis and/or dermis). CPT 11044 is reported for debridement of the bone, but includes debridement of the epidermis, dermis, subcutaneous tissue, fascia, and/or muscle (all layers of tissue above the bone). That’s why I say identify the “deepest” layer of tissue debrided because that will drive your code since the debridement of any more superficial layers in the same area/wound is included. It is also important to note that the more superficial layers of tissue are listed in parentheses in the code descriptions and are followed by the term if performed. This is also important because while the debridement of more superficial layers of tissue in a single wound or area should not be reported separately, debriding those more superficial layers is not required to utilize these codes. For example, you may have a case with an ulcer where the superficial layers have been eroded away, and the physician just debrides the muscle which is now exposed – you can still code CPT 11043.
What is the total area debrided (in square centimeters)? Sometime you luck out and the physician gives you the total square centimeters debrided (e.g. 25 square centimeters). Other times, you have to dust off your geometry skills a bit and calculate that. For example, if a physician states that a 5 cm x 5 cm area was debrided, you would multiple that length times width (5 x5) for a total of 25 square centimeters.
Coding Tip: Also be on the lookout for situations where physicians use a different unit of measure such as inches or millimeters instead of centimeters in their operative reports. Before calculating the total square centimeters, you first need to convert that alternate unit of measure into centimeters. Not sure how to do that? Google is your best friend! Type in “calculator to convert inches to centimeters” (or whatever units of measure you are trying to convert), and you will find plenty of helpful calculators like this one: https://www.inches-to-cm.com/. In our example of converting inches to centimeters, just type in the number of inches from the operative report, and Google will convert that to centimeters for you. Do this for both the length and the width of the wound. Once you have your measurements in centimeters, multiply those numbers together as before to calculate your area in terms of total square centimeters.
Why does knowing how to calculate total square centimeters matter? CPT codes 11042, 11043, and 11044 are coded for debridement of “the first 20 square centimeters or less” while CPT codes 11045, 11046, and 11047 are reported for “each additional 20 square centimeters or part thereof.” So being able to calculate the total square centimeters of area debrided is key to success. Finally the phrases “20 sq cm or less” “each additional 20 sq cm or part thereof” are important because you don’t need to see a full 20 sq cm of area debrided before applying these codes. For CPT codes 11042, 11043, and 11044, if debridement is performed for any area up to and including 20 square centimeters, you will report the appropriate code based on the deepest tissue debrided. If the debridement area is larger than 20 square centimeters, though (even marginally so as in 20.1 sq cm), you can report CPT codes 11045, 11046, or 11047 as well for “each additional 20 square centimeters or part thereof.” You do not need documentation of a full additional 20 square centimeters to use these codes. We will go through some examples in a moment to help illustrate this.
Question #4: Is there more than one area/wound debrided? If you answer no to this question, your work should be done by answering the first three questions. If you answer yes, though, you need to determine if the two wounds are debrided to the same depth or different depths. For example, if you had a wound on the left forearm debrided to fascia and another wound on the right thigh debrided to fascia, the two wounds would be debrided to the same depth. In this scenario, you would add together the total square centimeters of area debrided in the two wounds and code accordingly. However, if you had a wound on the left forearm debrided to fascia and a wound on the right thigh debrided to subcutaneous tissue, the two would be debrided to different depths. In this scenario, do not add together the total square centimeters of area debrided in the two wounds. Instead, code them separately.
Okay let’s put this all together with a couple of examples.
Example #1: A patient presents with a pressure ulcer on the right calf. The wound measures 6 cm x 3 cm. Debridement is performed down to and including fascia across the entire wound surface. What CPT code(s) should be reported?
Answer Example #1: First, we have our indication (pressure ulcer). If we search “debridement, pressure ulcer” or even “debridement, ulcer” to go a little more general in CPT, we have no unique codes to report for this indication. Then we have our depth (deepest layer of tissue removed is the fascia since debridement was “down to and including fascia”). Then we have our measurements (6 cm x 3 cm or 18 square centimeters when we multiply length times width). We also know that the “entire wound surface” is debrided. We do not have a second area/wound so our work is done. We have an area of 18 square centimeters (sq cm) debrided with the fascia being the deepest layer of tissue debrided which takes us to CPT 11043. This code is reported for the initial 20 square centimeters or less for debridement of the fascia and/or muscle.
Example #2: A patient presents with a stage IV sacral decubitus ulcer. The overlying skin, subcutaneous tissues, and fascia have eroded but necrotic muscle and bone remain. The wound (aka ulcer) measures 4 cm x 6 cm. Debridement is performed of the entire ulcer surface including the necrotic muscle and bone. A dry dressing was applied.
Answer Example #2: First, we have our indication (decubitus ulcer). Again if we search “debridement, decubitus ulcer” or “debridement, ulcer,” we have no unique codes to report for this indication. Then we have our depth (deepest layer of tissue debrided is necrotic bone). While the overlying muscle is debrided also, the debridement of this more superficial layer in the same wound/area is included in that deeper debridement of the bone. Then we have our measurements (4 cm x 6 cm or 24 square centimeters when we multiply length times width). We do not have a second area/wound so our work is done. We have an area of 24 sq cm debrided with the bone being the deepest layer of tissue debrided which takes us to CPT 11044 x1 and CPT 11047 x1. CPT 11044 is reported for the initial 20 square centimeters of debridement of the bone and CPT 11047 x1 is reported for “each additional 20 square centimeters or part thereof.” Since 4 sq cm is a part of 20 sq cm, we can add that 11047 x1 even though a full additional 20 square centimeters was not debrided.
Example #3: A patient presents with non-healing wounds on the left thigh and the left forearm. The thigh wound is 15 cm x 3 cm and the forearm wound is 4 cm x 6 cm. Both wounds are debrided to subcutaneous tissue across the entire wound surface area. What CPT code(s) should be reported?
Answer Example #3: First, we have our indication (non-healing wound). If we search “debridement, non-healing wound” or “debridement, wound,” we have no unique codes to report for this indication. Then we need to look at the deepest layer of tissue debrided in each wound – first in the left thigh and then in the left forearm. The deepest layer of tissue debrided is subcutaneous tissue for both. So we will add together the total area debrided in these two wounds since they were debrided to the same depth. Now we have our measurements. The left thigh wound is 15 cm x 3 cm (or 45 square centimeters when we multiply length times width), and the left forearm wound is 4 cm x 6 cm (or 24 square centimeters when multiply length times width). Now we will add 45 square centimeters and 24 square centimeters together for a total of 69 square centimeters. So we have a total area of 69 sq cm debrided with the subcutaneous tissue as the deepest layer of tissue debrided which takes us to CPT 11042 x1 and CPT 11045 x3. CPT 11042 is reported for the initial 20 square centimeters of debridement of the subcutaneous tissue leaving us 49 square centimeters left to report. CPT 11045 is reported for “each additional 20 square centimeters or part thereof” (the first unit of CPT 11045 captures 20 additional sq cm leaving us 29 sq cm to report; the second unit of CPT 11045 captures another 20 additional sq cm leaving us 9 sq cm left to report; and the third unit of CPT 11045 captures the remaining “part thereof” or 9 square centimeters for 69 sq cm in total).
Example #4: A patient presents with non-healing wounds on the right buttock and the left hand. The former is 4 cm x 5 cm and the latter is 2 cm x 3 cm. The buttock wound is debrided down to and including muscle and the hand wound is debrided down to and including subcutaneous tissue. What CPT code(s) should be reported?
Answer Example #4: First, we have our indication (non-healing wound). We’ve already established there are no unique codes for debridement for this indication so we will proceed to depth of debridement. Here, we see that the deepest tissue debrided in the buttock wound is muscle while the deepest tissue debrided in the hand is subcutaneous tissue. So the wounds are debrided to different depths. For this reason, we will not add the area of the two wounds together and will code them separately. Next, we have our measurements. The “former wound” (the buttock wound) is 4 cm x 5 cm (or 20 square centimeters when we multiply length times width), and the “latter wound” (hand wound) is 2 cm x 3 cm (or 6 square centimeters when we multiply length times width). So we have 20 square centimeters of debridement down to and including muscle (CPT 11043)and 6 square centimeters of debridement down to and including subcutaneous tissue (CPT 11042). Note that you will need to add modifier 59 or XS (separate site) to CPT 11042 to unbundle it from CPT 11043 and demonstrate to the payer that the two debridements were performed at different anatomic sites. The final modifier will be determined by the insurance carrier guidelines.
