With these services correct coding is all about the wound type.
When the physician performs multiple skin debridements for the same patient, you’ll need to know what separates a “surface” debridement from a deeper one, as it is the most important factor when coding these services.
The basics: Most physician practices will perform two types of debridement in-office. Report 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) if notes indicate that the physician debrides a “surface” wound (down to the epidermis or dermis). Opt for 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less) when the notes indicate that the debridement extended to the muscle/fascia.
For multiple debridements, your coding will depend on several encounter factors. Check out this quick advice on how to report coding for these basic skin surgeries.
The first type of multiple debridement involves your physician debriding wounds of the same depth, either in the same or in different anatomical areas. When the wounds are of the same depth, “you would add the surface area together and code based on the total surface area,” reports Catherine Brink, BS, CMM, CPC, CMSCS, CPOM, president of Healthcare Resource Management Inc. in Spring Lake, N.J.
Example: The provider debrides an 18 square cm wound on the patient’s right shin, and debrides another 20 square cm left thigh wound. Notes indicate that both repairs involved only the epidermis and dermis. On the claim, you would report 11042 for the first 20 sq cm of debridement space, and 11045 (… each additional 20 sq cm, or part thereof [List separately in addition to code for primary procedure]) for the remaining treatment area.
When the patient requires multiple debridements of different depths, report a code for each debridement with modifier 59 (Distinct procedural service) appended to the “component” code, explains Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.
The Correct Coding Initiative (CCI) typically bundles 11042 into 11043, but you can unbundle the codes with modifier 59 in certain circumstances — such as when the debridements occur on different injuries.
(Note: For payers that prefer you use the “X” modifiers instead of 59, you would choose one of the following: XE [Separate encounter]; XP [Separate practitioner]; XS [Separate structure] or XU [Unusual non-overlapping service].)
Example: Encounter notes indicate the physician debrided 5 sq cm of muscle and fascia on a patient’s right shoulder, and then debrides 11 sq cm of dermis and epidermis on her right chest wall. On the claim, you should report 11043 for the right shoulder debridement, and 11042-59 (or the appropriate X modifier) for the chest wall debridement.