“Can one appropriately bill a debridement code, such as CPT 11042, each time when applying a skin substitute if indicated in a hospital, outpatient wound care clinic?”
It is not appropriate to bill a debridement code (ie. CPT 97597, CPT 11042) each time when applying a skin substitute, whether the skin substitute is being applied in a hospital or an outpatient wound care clinic. The place of service has no bearing on this issue. Since the posted question is from the state of Ohio, I think that it would be important to access the appropriate LCD from Cigna Government Services (ie. CGS), LCD L36690 – Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities. The LCD states the following pertaining to the question that was raised:
“In all wound management the ulcer must be free of infection and underlying osteomyelitis with documentation of the conditions that have been treated and resolved prior to the institution of CTP therapy. For purposes of this LCD, appropriate therapy includes, but is not limited to:
- • Control of edema, venous hypertension or lymphedema
- • Control of any nidus of infection or colonization with bacterial or fungal elements
- • Elimination of underlying cellulitis, osteomyelitis, foreign body, or malignant process
- • Appropriate debridement of necrotic tissue or foreign body (exposed bone or tendon)
- • For diabetic foot ulcers, appropriate non-weight bearing or off-loading pressure
- • For venous stasis ulcers, compression therapy provided with documented diligent use of multilayer dressings, compression stockings of > 20mmHg pressure, or pneumatic compression
- • Provision of wound environment to promote healing (protection from trauma and contaminants, elimination of inciting or aggravating processes)”
As you can see, you cannot bill for a debridement code on the same date of service that a skin substitute is applied to the affected site. That being said, there is nothing within the LCD that states that a debridement service cannot be performed and billed for on a date of service PRIOR to the CTP application to ensure that there is no evidence of necrotic tissue within the site for the application of the skin substitute.
For those physicians that do not practice in the state of Ohio, I am sure that the corresponding LCD of your Medicare Administrative Carrier will state the same position as CGS.
This is my opinion.
Michael G. Warshaw
THE 2021 Podiatry Coding Manual is available in either Book or Flashdrive formats. It has been completely updated including the E/M coding changes for 2021. Many offices across the country consider this to be their “Bible” when it comes to coding, billing and documentation. The price is only $125 including shipping! To purchase, access the website drmikethecoder.com.
Are you in compliance with Medicare concerning your billing, coding and documentation? An audit should never be more than an inconvenience. It should not be a life altering event. Find
out your status before you are audited by your Medicare carrier. Drmikethecoder special: Have 5 dates of service audited for $250 (new clients only). Contact drmikethecoder.com for more information.