Debridement - Proper Documentation Crucial for Accurate Coding

DEBRIDEMENT - Proper Documentation Crucial for Accurate Coding

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Debridement is a key element in hospital and ambulatory surgical center (ASC) medical billing. Physicians remove unhealthy tissue from a wound using excisional and non-excisional techniques. However, lack of proper documentation often leads to miscoding of surgical wound debridement and this has made debridement claims a target of recovery audit contractors (RACs) and also by the Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS). Medical coding outsourcing companies can ensure errorfree claim submission only if the physician meets the stringent documentation requirements for reporting surgical debridement.

Different Types of Debridement Debridement involves the removal of necrotic or dead tissue to establish a viable margin, reduce risks of infection and promote wound healing. In addition to necrotic tissue, tissue necessary to establish a viable margin includes senescent cells, rolled skin edges, undermined edges, and abnormal granulation tissue. The different types of debridements are: -

Excisional

-

Selective, and

-

Non-selective

Each category has its own set of CPT codes.

There are different methods of wound debridement -- surgical, mechanical, autolytic, biologic, enzymatic, and other approaches.

ICD-10 defines excision as cutting out or off, without replacement, a www.outsourcestrategies.com

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portion of a body part and excision debridement is considered as a surgical procedure.

Surgical excision includes going slightly beyond

the point of visible necrotic tissue until viable bleeding tissue is encountered in some cases. The use of a sharp instrument does not necessarily

validate

the

performance

of

surgical

excisional

debridement.

For the procedure to be coded as excisional debridement, the health care provider needs to specifically document “excisional debridement”.

A 2011 American Academy of Professional Coders (AAPC) report stresses the importance of using the “right words” to document excisional debridement. According to the report, the five elements of complete documentation for excisional debridement are: - A description of the procedure as “excisional” - A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel,

curette)

- A description of the tissue removed (e.g., necrotic, devitalized or non-viable) - The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7

cm x 10 cm, etc.)

- The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue,

muscle, or bone)

CPT also provides the following guidelines to support an accurate code assignment: - For a single wound, report the depth based on the deepest level of tissue removed.

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- For multiple wounds, sum the surface areas that are at the same depth (do not combine

sums from different depths).

Excision Debridement on the Skin - CPT Codes  CPT codes 11000-11012: These codes describe removal of extensive eczematous or infected skin.

11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface 11001 each additional 10% of the body surface, or part thereof (to be listed separately in addition to primary procedure)  11001 is used in conjunction with 11000 11004 Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum 11005 abdominal wall, with or without fascial closure 11006 external genitalia, perineum and abdominal wall, with or without fascial closure 11008 Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to primary procedure)  11008 is used in conjunction with 10180, 11004-11006  11008 should not be reported in conjunction with 11000-11001, 11010-11044  Skin grafts or flaps should be reported separately when performed for closure at the same session as 11004-11008

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11010 Debridement including removal of foreign material at the site of an

open

fracture

and/or

an

open

dislocation

(eg,

excisional

debridement); skin and subcutaneous tissues 11011 skin, subcutaneous tissue, muscle fascia, and muscle 11012 skin, subcutaneous tissue, muscle fascia, muscle, and bone  Surgical Debridement (CPT codes 11042-11047) Surgical debridement is reported only if material has been excised, and is typically used for wound treatment to clear the site of devitalized tissue including necrosis, eschar, slough, infected tissue, abnormal granulation tissue etc., to the margins of viable tissue. These codes are appropriate for treatment of skin ulcers, circumscribed dermal infections, conditions affecting contiguous deeper structures, and debridement of deep-seated debris from any number of injury types. Surgical debridement codes as performed by physicians and qualified non-physician practitioners licensed by the state to perform those services are reported by depth of tissue removed and by surface area of the wound.

11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle, and/or fascia, if performed); first 20 sq cm or less

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11045 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to primary procedure)  11045 is used in conjunction with 11042 11046 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to primary procedure  11046 is used in conjunction with 11043 11047

Debridement,

bone

(includes

epidermis,

dermis,

subcutaneous tissue, muscle, and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to primary procedure)  11047 is used in conjunction with 11044 Paring or Cutting 11055 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion 11056 two to four lesions 11057 more than four lesions Selective and Non-selective Debridement Unless

the

medical

record

indicates

that

surgical

excisional

debridement has been performed, debridements should be coded with either selective or non-selective codes

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 Selective debridement (CPT 97597 and 97598) Active wound care, performed with minimal anesthesia is billed with either CPT code 97597 or 97598 (e.g. high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (e.g.. 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, total wound(s) surface area).

-

97597 is used to bill for debridement of the first 20 cm² of aggregate wound size and CPT 97598 for any subsequent 20 cm² increments of debrided tissue.

-

97597 and/or 97598 are billed for recurrent wound debridements when medically reasonable and necessary.

-

These codes are not limited to any specialty as long as debridement is performed by a health care professional acting within the scope of his/her legal authority.

-

97597 and 97598 require the presence of devitalized tissue (necrotic cellular material). The mere removal of secretions (cleansing of a wound) does not represent a debridement service.

-

In

physical

(whirlpool)

therapy

with

documentation

CPT

must

medical codes

reflect

billing

97597

of

or97598,

hydrotherapy

as

hydrotherapy the a

clinical

medically

necessary component of the total wound care treatment for removing of devitalized and/or necrotic tissue and that the

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physical therapist’s skills were required to perform this service in the given situation.  Non-Selective Debridement (97022, 97036, 97602) 97022 Whirlpool; Application of a modality to one or more areas; whirlpool, supervised 97036 Whirlpool; Application of a modality to one or more areas; Hubbard tank, constant attendance 97036 97602 Debridement, non-selective; Removal of devitalized tissue from wound(s); nonselective debridement without anesthesia (e.g. wet-tomoist dressing, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.

(Note: 97602 remains available for optional use by non Medicare payers only).

Procedural coding errors can lead to lost revenue or unintentional upcoding at ambulatory surgery centers, according to the Texas Medical

Association.

When

it

comes

to

debridement,

the

documentation in the medical record should reflect what type of debridement was performed and be clear as to why it was done. With precise documentation, medical coding service providers can ensure accurate code assignment, promoting clean claims and reduced risk of audits. Expert codes would also be knowledgeable about the unique characteristics of each debridement code as well payer guidelines for reporting them on claims.

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