“My practice involves a lot of wound care and I frequently take patients to the operating room for a debridement involving a wound and bone with osteomyelitis. I always code this type of procedure as CPT 11043 and CPT 11044. I feel that this is justified because I am debriding the soft tissue structures (CPT 11043) but also the bone (CPT 11044). I was discussing this with a colleague and she suggested that this might not be appropriate.”
The colleague of the physician/surgeon that suggested that the fashion in which the procedure was coded was correct in her assessment. It was not appropriate. By billing CPT code 11043 which is defined as: Debridement, muscle and or fascia (includes epidermis and dermis, and subcutaneous tissue if performed); first 20 sq. cm or less) AND CPT code 11044 which is defined as: Debridement, bone (includes epidermis and dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq. cm or less, the information that is being provided to the health insurance carrier is that two, separate, unrelated ulcerations/wounds are being addressed procedurally. One wound/ulcer is having necrotic muscle and /or fascia in addition to any overlying tissue including epidermis and dermis, and subcutaneous tissue that is necrotic excisionally debrided. The other wound/ulcer is having necrotic bone in addition to any overlying tissue including epidermis and dermis, subcutaneous tissue and muscle and/or fascia hat is necrotic excisionally debrided. If this was indeed the case, which clearly it is not, the correct fashion to code the scenario would be:
CPT 11044
CPT 11043- 59
When you read the LCD of the various Medicare Administrative Carriers regarding the treatment or the derbidement of ulcers or wounds, it is extremely important to be aware of the following points of information:
1. Indicate the type of tissue or material removed from the wound or ulcer.2. The tissue or material must be necrotic. This is the sole factor that determines the debridement code to bill.
3. The selected debridement code is based upon the deepest level of necrotic tissue that is excisionally debrided from within the ulcer.
The scenario that was described clearly identifies CPT code 11044 as the ONLY CPT code that should have been billed. Despite the fact that the physician/surgeon feels that it is “justified” to bill CPT code 11043 in addition to CPT code 11044 for the same wound based upon the fact that he is “debriding the soft tissue structures but also the bone,” it is just incorrect to do so. All that you need to do is read the definition/description of CPT code 11044. ALL of the overlying soft tissue that is excisionally debrided in addition to the necrotic bone is included in CPT code 11044. That is why I ALWAYS opine how important it is to know the rules and to read the definitions of the CPT codes, not just bill them.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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