coding debridement with skin graft

Should we drop Mods 59s and instead use XSs, for both 11042 and 11043? A: It depends on the documentation. The National Correct Coding Initiative (NCCI) bundles skin substitute graft codes 15271-+15277 with skin and subcutaneous debridement code 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less). U.+"x/J>DcB cm; we know that many times the actual size of the skin substitute is larger than the area that was covered. In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. Revenue Codes are equally subject to this coverage determination. The treatment plan for a patient who requires frequent repeated debridement should be reevaluated, to ensure that pressure reduction and infection control have been adequately addressed. 0000006836 00000 n . apply equally to all claims. Answer: Therefore, the more accurate code is a surgical preparation code (15002 15005) for excision (note the term is not debridement) of the open wound to prepare a viable wound surface for grafting. I work in an acute care center with a burn unit and . If you miss the separate skin preparation step, youll sacrifice pay your surgeon deserves. Wound debridement is a medical procedure that removes infected, damaged, or dead tissue to promote healing. Reproduced with permission. In your example, you will be closing the wound. 0000017393 00000 n The following procedures are considered part of active wound care management, and are not considered as debridement and are not included in the related LCD: Removal of devitalized tissue from wound(s), non - selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care. Table 2 summarizes the coding matrix for the new skin substitute graft codes. If the documentation supports that 20 sq. "JavaScript" disabled. that coverage is not influenced by Bill Type and the article should be assumed to Per the MFSDB - payment for bilateral procedures does not apply. This code is based on a wound size (singular or aggregate size; after cleansing, prepping, and/or debriding) minimally of 100 sq cm*. cm and Applicable FARS/HHSARS apply. If the provider debrides and sends samples for tissue typing to determine the appropriate depth, pathology found cartilage, is this considered 11044/bone? Photographic documentation of wounds either immediately before or immediately after debridement is recommended for prolonged or repetitive debridement services (especially those that exceed five extensive debridements per wound (CPT code 11043 and/or 11044)). of the Medicare program. iv. 1279 0 obj <>/Filter/FlateDecode/ID[<8B4464A13AA9C745B5A6304A9784D76D>]/Index[1253 57]/Info 1252 0 R/Length 97/Prev 314542/Root 1254 0 R/Size 1310/Type/XRef/W[1 2 1]>>stream In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. The AMA assumes no liability for data contained or not contained herein. Include cleaning: When the surgeon performs a simple cleansing of the wound, that service is included within the skin substitute procedure codes, according to CPT instruction. You can use the Contents side panel to help navigate the various sections. Tip 3: Know Whats Included The following products may be billed with CPT codes 15430-15431 . Examples of the inappropriate use of these codes are ulcers, furuncles, and localized skin infections. Remember: Wound surface area is what you should consider when selecting the code, not the size of the graft, cautions Arnold Beresh, DPM, CPC, CSFAC, in West Bloomfield, Michigan. CPT codes 11000 and 11001 are not appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion. Code Debridement by Documented Depth and Area When reporting debridement of a bedsore, code selection depends on the depth of debridement and total area debrided: Depth to subcutaneous tissue (to the depth of blood vessels and nerves): 11042 (first 20 sq cm) and +11045 (each additional 20 sq cm, or part thereof) Service: The work described by these codes involves preparing a clean, viable wound surface for graft placement to heal by primary intention (not secondary intention). Do not report 11042 -11047 in conjunction with 97597-97602 for the . Debridement Debridement of subcutaneous tissue (e.g., Current Procedural Terminology (CPT) codes 11042 and 11045, if appropriate) is considered appropriate codes to use when performing a non-surgical application of a skin substitute. What does Separate Procedure Mean in a CPT Code Description? The AMA does not directly or indirectly practice medicine or dispense medical services. This is reported with a single code, 11044. The surgeon may choose to leave the wound open in anticipation that healthy tissue will grow over the ulcer site. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. 1 I work in an acute care center with a burn unit and have been striving for accuracy and consistency. cm and then debridement codes (with an appropriate modifier) for the remaining 65 sq. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom In the presence of documented significant ischemic disease with necrotic ulceration, extensive and definitive debridement may be required. complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE, DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); FIRST 20 SQ CM OR LESS, DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; FIRST 20 SQ CM OR LESS, DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUDATE, DEBRIS, BIOFILM), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, USE OF A WHIRLPOOL, WHEN PERFORMED AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION, TOTAL WOUND(S) SURFACE AREA; EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), Some older versions have been archived. Bilateral Carpal Tunnel Procedures Different Days, Multiple Laminectomies to Place a Spinal Cord Stimulator. |S=LqO=Vz endstream endobj startxref *4 Use CPT code 15340-15341 or CPT code 15360-15366 for the surgical preparation or creation of recipient site for the tissue skin graft. %%EOF Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable. required field. The physician documentation is the key to being able to support both codes. Tip 2: Identify Type of Skin Substitute Graft Q: I have been trying to determine whether a skin graft includes debridement. hb```f``e`2jx Y8t00:00@9@ 6 jx The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.) This note should describe the anatomical location treated, the instruments used, anesthesia used if required, the type of tissue removed from the wound, the depth and area of the wound and the immediate post procedure care and follow-up instructions. cm or less). Application of Bioengineered Skin Substitutes and Skin Grafting is performed on ulcers that are free of . The objective of the procedure is to . hb```, cc`a4`` $0oP>+Z5:,PaE$L[R\w0`r`,p{^gnq))&%xBiS*,8yUSc3AOSAk*+L|0$nELLuH0|Rfp1drcH/i*@r? Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. rW`n":Q5g%_7:j)j9."QFGH(2My"hqt}%%l}]KkWmNhlI,(PjqK9%.v#|3^ya%h'e'e2iB@iFOk|q)7 If.ug q&QP;jNy>9cW=aB=je>m3/dDQMA;2VJ0E5&Qj2[iG"^l+E. 1 G/r f VY;fuC{r@,>^Q k1[1Q3#V^DJ;;j!E"&~'/;{1M, ~ B ^(\%@%t m+?Rh@yK Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (, o Total site less than 100 sq cm: 15271 first 25 sq cm or less; +15272 each additional 25 sq cm, o Total site 100 sq cm or more: 15273 first 100 sq cm (or 1 percent body area infants and children); +15274 each additional 100 sq cm (or 1 percent body area infants and children), Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits, You can still separately code for deep debridement that includes muscle and bone, says, Grasp measurement rules. Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. An asterisk (*) indicates a Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. As you can see, procedure code 86.69 (other skin graft to other sites) includes the debridement and closure of the amputation site via split-thickness skin graft. Even a minor breach of patient protected health information (PHI) or [], Question: We have a new surgeon in our practice who specializes in vascular surgery, and [], Question: When our surgeon rounds on a patient in the critical care unit, can we [], Question: When and how should we use external cause codes? For services related to removal of callus (hyperkeratotic tissue) around an ulcer, paring or cutting of corns, trimming or debridement of nails, please refer to NGS LCD Routine Foot Care and Debridement of Nails (L33636). Answer: Debridement is considered a separately reportable procedure when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue is removed, or when debridement is carried out separately without an immediate primary closure. American Hospital Association ("AHA"), Reader Question: Distinguish Additional Lesion Excision Method, CCI Edits: Navigate Surgery Bundles That Could Compromise Your Pay, ICD-10 Changes: Master Guidelines for Infection, Sepsis. Rather, it is removal of devitalized tissue, necrosis, and slough by other methods, including: Examples of non-excisional debridement are pulsed lavage, mechanical lavage, mechanical irrigation, high-pressure irrigation, etc. John Verhovshek, MA, CPC, is a contributing editor at AAPC. In most instances Revenue Codes are purely advisory. %PDF-1.5 % Skin replacement surgery consists of two basic steps: surgical preparation of the recipient site and placement of the graft with fixation. 0000027593 00000 n These codes are used for wound debridement but only when you are debriding an open wound with no intention of closing it; you expect the wound to heal by secondary intention. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. Coding matrix for the new skin substitute graft codes For multiple wounds, sum the surface area of all wounds requiring grafts from the same anatomic site and report the applicable primary code and add-on code in multiples, as appropriate. Youve learned that you can separately report the site preparation and the skin substitute graft placement procedures, but you may wonder what other services and materials in the op report are separately billable. If you miss the separate skin preparation step, youll sacrifice pay your surgeon deserves. My plastic surgeon debrided an open burn wound that was 45 sq cm then placed a split thickness skin graft over the wound. Some articles contain a large number of codes. End User Point and Click Amendment: cm of skin substitute application (15271). Determining the wound location and surface area is important in order to select the appropriate CPT code. o Total site 100 sq cm or more: 15273 first 100 sq cm (or 1 percent body area infants and children); +15274 each additional 100 sq cm (or 1 percent body area infants and children), o Similar code pairs based on area: 15275 and +15276; 15277 and +15278. 0000000936 00000 n 0000002591 00000 n 39 0 obj <>stream Autologous skin grafts are those that the surgeon harvests from another healthy part of the patients own body, and you would use different codes for those graft procedures. 1 Is this right? When debridements are performed, the debridement . 5. 11042 for a Stg III Pressure Ulcer, and for a separate much deeper Stg IV Pressure Ulcer, 11043, will not pay together, despite using Mods 59 and 58 for both with our twice-weekly, excisional surgical debridement. This email will be sent from you to the Skin substitute graft application code selection is based on defect site location and size. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or authorized with an express license from the American Hospital Association. KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. 0000010293 00000 n Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits Reduction of pressure and/or control of infection will facilitate healing and may reduce the need for repeated debridement services. No. Distinguish the codes based on body site, as follows: used to report this service. End Users do not act for or on behalf of the CMS.

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