coding debridement with skin graft

0000007521 00000 n The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.) without the written consent of the AHA. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Draft articles have document IDs that begin with "DA" (e.g., DA12345). Procedures involving the wrist and/or ankle are reported with codes that include arm or leg in the descriptor. twZ5C2ayV`C~1S6#9mOk)d4sr$#yd:W8 Eu1EgZ \ 0 E endstream endobj 49 0 obj <>stream 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 article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Debridement Services. hUmo0+q 0HUmIkN^D Wk$$[n;=AIWq@ The AMA is a third party beneficiary to this Agreement. Applicable FARS\DFARS Restrictions Apply to Government Use. Remember that the debridement codes, 11042-11047, are reported when you debride an open wound that will stay open to heal by secondary intention. 43 32 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. When can I report a debridement in addition to a graft? 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 a physician uses a curette to debride slough on the surface of the wound is that classified as subcutaneous or non-surgical? In your example, you will be closing the wound. Add together the surface area of multiple . 11012 skin, subcutaneous tissue, muscle fascia, muscle and bone. that coverage is not influenced by Bill Type and the article should be assumed to *This response is based on the best information available as of 4/11/19. 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. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Addition to Skin Graft Codes 15271-15278 is the new CPT code series for skin substitute grafts. A description of the tissue removed (e.g., necrotic, devitalized or non-viable) Appropriate changes in the ongoing treatment plan to reflect the clinical presentation must be present in the record. In addition to the type of graft material, the surgeon should also document site preparation and wound size, and number and location of grafts, according to Beresh. Instructions for enabling "JavaScript" can be found here. Include simple debridement: Skin replacement grafts include simple debridement of granulation tissue or recent avulsion. Some articles contain a large number of codes. cm of the total 85.25 sq. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available. This article was converted to the new Billing and Coding Article format. In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. 0000001292 00000 n 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? However, we do not recommend the 11042 - 11047 codes. iC>:D~c~V*H0"Q%L]5CB CPT codes 11042-11047 should be used for debridement of relatively localized areas depending upon the involvement of contiguous underlying structures. iv. A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette) Therefore, the more accurate code is a surgical preparation code (15002 15005) for excision (note the term is not debridement) of the open wound to prepare a viable wound surface for grafting. 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. Prior treatment by a physician, non-physician practitioner, nurse and/or therapist, Description of wound: length, width, depth, grid drawing and/or photographs, Amount, frequency, color, odor, type of exudate, Evidence of infection, undermining, or tunneling, Comorbidities (e.g., diabetes mellitus, peripheral vascular disease), Skilled plan of treatment, including specific frequency, modalities and procedures, Type of debridement performed, including instrument used, to support the debridement code billed, Changing plan of treatment based on clinical judgment of the patients response or lack of response to treatment. "JavaScript" disabled. Sign up to get the latest information about your choice of CMS topics in your inbox. 0000015008 00000 n endstream endobj 26 0 obj <> endobj 27 0 obj <> endobj 28 0 obj <>stream cm involved a skin substitute application, you can report 15271 for the 20 sq. The National Correct Coding Initiative (NCCI) bundles skin substitute graft codes 15271-+15277 with skin and subcutaneous debridement code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less). The views and/or positions and Full Thickness Skin Grafts Code range for STSG -15100 (Trunk, arms and legs) -15120 (Face, scalp, eyelids, mouth, neck, ears . Current Dental Terminology © 2022 American Dental Association. |S=LqO=Vz 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) an effective method to share Articles that Medicare contractors develop. 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. Coding and Billing for Skin Substitute Grafts Skin substitute graft application code selection is based on defect site location and size. For example: Bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer. CPT codes 11000 and 11001 are not appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion. 8u-0=*.tCOeF8h`TLeHRzLco`@X(d9rFdcG VA,P&l cm and This is reported with a single code, 11044. Your coder is correct simple debridement is included in the graft codes. 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. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. 0000022753 00000 n He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. Examples of the inappropriate use of these codes are ulcers, furuncles, and localized skin infections. In cases of excessive frequency or prolonged duration of treatment, documentation should include an evaluation for possible infection (e.g. You will see two additional references: benign and malignant. "JavaScript" disabled. 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC Answer: The procedure is essential for wounds that aren . 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. End User License Agreement: Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. *This response is based on the best information available as of 09/05/19. Select Debridement Codes by Depth. 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. If your session expires, you will lose all items in your basket and any active searches. 15002 and +15003 for trunk, arms, legs (including wrist or ankle) %%EOF 0000016096 00000 n Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (, o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm, o Total site 100 sq cm or more: 15273 first 100 sq cm (or 1 percent body area infants and children); +15274 each additional 100 sq cm (or 1 percent body area infants and children), Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits, You can still separately code for deep debridement that includes muscle and bone, says, Grasp measurement rules. 7500 Security Boulevard, Baltimore, MD 21244. Copyright 2023, AAPC 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. Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable. End User Point and Click Amendment: In CPT, coding these grafts by size is a novel concept. I work in an acute care center with a burn unit and have been striving for accuracy and consistency. Organizations who contract with CMS acknowledge that they may have a commercial CDT license with the ADA, and that use of CDT codes as permitted herein for the administration of CMS programs does not extend to any other programs or services the organization may administer and royalties dues for the use of the CDT codes are governed by their commercial license. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. 5. Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. required field. Incision and debridement, right knee Exchange arthroplasty liner of right total knee arthroplasty OPERATIVE NOTE: . 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. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. 11042 for a Stg III Pressure Ulcer, and for a separate much deeper Stg IV Pressure Ulcer, 11043, will not pay together, despite using Mods 59 and 58 for both with our twice-weekly, excisional surgical debridement. Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (Application of skin substitute graft ). If the documentation supports that 20 sq. /| Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. 0 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. Supportive Documentation Requirements (required at least every 10 visits) for 97597 and 97598: Medical records must be made available to Medicare upon request. 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). If any of these elements is missing, documentation does not meet the criteria for excisional debridement. If you are experiencing any technical issues related to the search, selecting the 'OK' button to reset the search data should resolve your issues. In most instances Revenue Codes are purely advisory. Applications are available at the American Dental Association web site. 0000004501 00000 n 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.

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