Health Information Management

Tip: Count total area for wound debridement

APCs Insider, August 10, 2012

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When coding multiple debridements on the same level, such as three subcutaneous debridements, ­coders should total the surface area debrided and select the appropriate codes.

For example, a physician documents a 26 sq cm debridement to the muscle of the upper right arm, a 15 sq cm debridement to the muscle of the right shoulder, and a 16 sq cm debridement to the muscle of the lower right arm. The coder would add all three areas together for a total of 57 sq cm and report 11043 for the first 20 sq cm and 11046x2 for the remaining 37 sq cm.
If the physician documents debridements to ­different levels at the same anatomical site, report only the deepest debridement. If the physician documents different levels of debridement at different anatomical sites, coders should report both debridements and append modifier -59 (distinct procedural service) to the shallower debridement.
For example, the physician documents a 14 sq cm debridement to the bone on the patient's left leg and a 35 sq cm subcutaneous debridement of the patient's left arm. Coders would report 11044 for the left leg debridement and 11043-59 and 11046-59 for the left arm.
Remember as well that coding is based on the surface area after the debridement. ­Coders should look for documentation of the type of tissue removed and whether the wound is larger. This will assist them in deciding whether to bill ­excisional codes or removal of nonviable tissue codes. For an excisional debridement, the post-debridement wound size should always be larger because the physician is removing living tissue.      
The tip is adapted from “Differentiate between types of wound debridement” in the June Briefings on APCs.

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