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Coding for debridement by Jenny Jackson, MPH

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n the 2011 Current Procedural Terminology
( CPT) * h andbook, the subsection heading
“Excision and Debridement” has been revised to refer only to “Debridement.” As a result, codes have been deleted, and new debridement codes have been added. Additionally, the active wound care management and debridement of open fracture codes have been revised to correspond with current clinical practice.
Debridement is a common procedure appearing throughout the CPT book. It is often used to remove foreign material or damaged, dead, or contaminated tissue from a surgical field, wound, or injury. The purpose of debridement is to help promote healthy healing of damaged skin, tissue, muscle, or bone.
When to use a debridement code
The debridement of small amounts of devitalized or granulation tissue during a surgical procedure is typically not billed separately. However, debridement is separately billable when it makes up a significant portion of the procedure.
The debridement codes listed in the table on page 39 do not include repairs, whether done at the same operative session or at a later date. It is appropriate to code separately for an intermediate, complex, or reconstructive repair if performed after a debridement. For example, for debridement of a 20 sq cm injury on the left leg including subcutaneous tissue closed with complex repair, code 13121, 13122, 13122, 13122, and 11042–51.
Depth and surface area
Starting this year, all wound debridements should be reported by depth of tissue removed and by surface area of the wound. Codes 11042,
11043, and 11044, which previously were used to report debridement of subcutaneous tissue, muscle, or bone, respectively, have been revised.
These three codes are now used to report deAll specific references to CPT (Current Procedural Terminology) terminology and phraseology are © 2010 American Medical
Association. All rights reserved.

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bridement of the first 20 sq cm or less of tissue, muscle, or bone. For example, the debridement of a 7.5 sq cm wound on the left hand that includes subcutaneous tissue is coded with 11042.
Three new add-on codes (11045, 11046, 11047) will be used to report each additional 20 sq cm, or part thereof, of subcutaneous tissue, muscle, or bone in conjunction with 11042, 11043, and
11044. When choosing codes to report, keep in mind that the CPT code numbers are out of sequence. The code pairs for the first 20 sq cm and each additional 20 sq cm are: 11042 with 11045,
11043 with 11046, and 11044 with 11047. For example, if the debridement listed above also requires removal of muscle and bone, code 11044.
If debridement of a single wound is required, the deepest level of tissue removed is used to report the service. However, if multiple wound debridements are performed, sum the surface area of those wounds at the same tissue depth, but do not combine sums from different depths.
For example, for the debridement of an 8 sq cm wound on the right hand, 20 sq cm wound on the left thigh, and a 10 sq cm wound on right leg that all include subcutaneous tissue and muscle, code as follows:
• 11043, Debridement, muscle and/or fascia
(includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm
• 11046, Debridement, muscle and/or fascia
(includes epidermis, dermis, and subcutaneous tissue); each additional 20 sq cm
Active wound care management
Active wound care management codes describe the removal of devitalized and/or necrotic tissue and promote healing. Codes 11040 and 11041, previously used to report debridement of partial or full thickness skin, have been deleted. To report debridement of skin (dermis or epidermis), use the active wound care management codes
97597 and 97598. These codes also have been revised to report the first 20 sq cm or less of total wound surface area (97597) and each additional

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