A review of payments for surgical wound debridement services released in 2007 by the Office of Inspector General revealed that Medicare had made nearly two-thirds of these payments in error.
Most commonly, the services were miscoded or lacked proper documentation. CPT codes 11040-11044 describe surgical debridement performed by physicians. Keep these points in mind when using this code set:
- Excision or not: Select the appropriate CPT code for billing based on the technique you have documented. Your documentation must verify the surgical excision of tissue (not just "scraping") in order to bill codes 11040-11044.
- For nonexcisional debridement, bill using codes 97597-97602. (These usually are reported by nonphysicians for selective and nonselective debridement procedures, and are not to be reported with codes 11040-11044.)
- When the service provided is only a nonsurgical cleansing of a wound without debridement, with or without the application of a surgical dressing, use the appropriate evaluation and management code, not a debridement code.
- Tissue removed, not depth of wound: Be sure to bill with a surgical debridement code that accurately reflects the level of tissue, muscle, or bone removed during the debridement. Some physicians mistakenly code the level of debridement based on the depth of the wound, as opposed to the extent of the tissue removed.
- Multiple wounds: You may bill debridement codes11040-11044 only once per lesion per debridement session. However, you may use codes 11040-11044 more than one time in a single patient encounter to report debridement of multiple wounds. Select the appropriate code for each site, and attach modifier 59 (distinct procedural service) to the additional codes.
Coding Medicare Claims
TrailBlazer developed a Local Coverage Determination offering specific coding guidance and requirements for Texas Medicare claims relating to surgical wound debridement. Be sure to follow these rules in your Medicare claims.
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