Debridement

“I was working at the local wound care clinic last week when this scenario presented itself. The patient was referred from the emergency room for follow for a wound. His wound was a deep wound at the medial malleolus of the right ankle. The posterior tibial tendon was right there, as clear as day. There was necrotic and fibrotic tissue around the tendon. I debrided the area, including the tendon, and all surrounding non-viable tissue. The patient had a superficial wound at the right hallux. Here are my questions: 1. Can we bill CPT 11043 and CPT 11044 in a wound care center? 2. Are we allowed to bill more than one wound debridement during the same visit? 3. Can I bill an E/M for the hallux wound, if only debrided the ankle wound?”

“The patient initially had a gastroc recession at the right lower extremity. Our surgeon performed a debridement procedure of the right foot ulceration. It was performed in the clinic, and we planned to code it as CPT 11042. However, the patient is in the 90-day post op period from the initial surgery that was performed 4 weeks ago. Is a modifier necessary to submit for payment? Is it 79?”

Can an Unlicensed Individual Perform Nail Debridements Under the License of a DPM and Can the Service be Billed to Medicare?

“Is the debridement of a plantar keratosis (CPT 11055) at the first metatarsal head considered bundled with nail debridement (CPT 11720)?”

“For Medicare, it has been well established that debridement for callouses is not covered when class findings are not present. But what about that patient that complains of pain from a callus. If you evaluate the painful callus and manage the painful callus, would it not be appropriate to bill a low level E/M code? This patient does not want surgery but this is a recurring problem. Can the E/M be billed each time the patient is seen?”

“Is a plantar keratosis debridement (CPT 11055) at the first metatarsal head considered bundled with nail debridement (CPT 11720)?”

“The patient is a 47 year old with a soft tissue mass over the distal fibula. It appears to be a gouty tophus and x-rays show no bone involvement. What would be the proper code for surgical debridement/excision of this mass?”

“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?”

“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.”

“I am trying to educate my physician about the documentation requirements for CPT 11721. He doesn’t think it’s important to document the number of nails debrided or even the method of debridement. Is there a resource you can point me to that specifically addresses this?” This was addressed last week. “Since it is stated – CPT 11721: Debridement of nail(s) by any method(s); 6 or more, why would it be necessary to document what instruments were used for debridement since any method would be accepted under this description?” This is part 2.