Reporting Debridement Services in the Emergency Department
There are a variety of different options for reporting medical services to do with wound debridement, depending on the kind of debridement performed. Excisional, selective, and non-selective debridements are all coded, reported, and billed differently.
To learn the details of billing for different kinds of wound debridement services, read the article below by Stacie Norris, MBA, CPC, CCS-P, Director of Coding Quality Assurance.
CPT gives several different options for reporting wound debridement services, depending on the type of debridement performed: excisional, selective or non-selective. Excisional debridement services are coded based on the deepest layer of viable tissue removed. One of the most common CPT codes used for reporting excisional wound debridement codes in the ED is CPT 11042-Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) first 20 sq cm or less. The provider’s documentation for CPT 11042 (and all debridement services) must include the level of tissue removed, method of tissue removal, and surface area of the wound in sq cm. Note that it must be at least at the subcutaneous level to support reporting CPT 11042.
There are additional codes for when greater than 20 sq cm tissue are debrided. There are also excisional debridement codes for muscle or fascia debridement (CPT 11043) and bone debridement (CPT 11044). CPT also provides the explanatory note: “For debridement of skin [ie, epidermis and/or dermis only] see 97597, 97598). CPT 97597 and 97598 are in the Active Wound Care Management section and are for reporting selective debridement (no living tissue is removed).” Active Wound Care Management codes are not frequently reported in the ED setting, but if the physician documentation supports that these services were performed then they may be coded and billed. From the physician documentation standpoint, it is clear from the above description of all the debridement codes available in CPT, that is very important that the physician document a detailed procedure note for any debridement services performed so that the most accurate and specific debridement CPT code may be utilized.