appropriate codes to use when performing a non-surgical application of a skin substitute. 0000018702 00000 n The AMA assumes no liability for data contained or not contained herein. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential 11012 skin, subcutaneous tissue, muscle fascia, muscle and bone. hVmo6+ER|l%v5/:Bm#e'b|x;CA\X&V@[ ElBdd B()"8$^DHhFTDv):7^L]c"BJ#=,'$T#BJ! Applicable FARS\DFARS Restrictions Apply to Government Use. Please do not use this feature to contact CMS. 2021 Evaluation and Management Codes: Is a History Required? Complete absence of all Revenue Codes indicates If all four wounds were debrided on the same day, apply modifier 59 Distinct procedural service with either 11042 or 11044, as appropriate. The patient's medical record must contain documentation that fully supports the medical necessity for services included withinthe related LCD. Many claims for debridement are essentially dressing changes and are not separately payable. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or A: It depends on the documentation. trailer <<1D25FBD66AB6418699B8EC89A49470A5>]/Prev 196840>> startxref 0 %%EOF 74 0 obj <>stream 3]HE1}}&Z\d3aD)6C~NYZgois\t-w;s3N>dgp@GtBisMaq)%le"Z\g.j4 9qEb*NLaQD\/z a\)DC|[JkHHq\J.d&X. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. Tip 2: Identify Type of Skin Substitute Graft. All Rights Reserved. As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Not exactly. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. "JavaScript" disabled. Guidance on these codes is available in the Bill type and Revenue code sections. 0000030507 00000 n HLN>bE+hAi .xiJ2D4>"A_6N@f("nChK!`=x;c` DIS!Sf8_c^x)$ cm. The AMA does not directly or indirectly practice medicine or dispense medical services. iC>:D~c~V*H0"Q%L]5CB 0000000016 00000 n Wound debridement is a medical procedure that removes infected, damaged, or dead tissue to promote healing. The document is broken into multiple sections. a$EdK@#)6e|y~#5H. 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? By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. Continuation of treatment plan with ongoing evidence of the effectiveness of that plan, including diminishing area and depth of the ulceration, resolution of surrounding erythema and /or wound exudates, decreasing symptomatology, and overall assessment of wound status (such as stable, improved, worsening, etc). The Current Procedural Terminology guidelines state that debridement is considered a separate procedure "when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure." ii. cm or less). 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 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). Specifically, this code is to be used for application of a skin substitute graft to a wound surface area size of 100 up to 200 sq Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, The surgeon may choose to leave the wound open in anticipation that healthy tissue will grow over the ulcer site. 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. This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Biological implants 0000004501 00000 n Your MCD session is currently set to expire in 5 minutes due to inactivity. 0000044306 00000 n 15271-15278 is the new CPT code series for skin substitute grafts. Codes 15002-15005 apply specifically to describe the work of "preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy," according to CPT guidelines. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, AMA Plaza 330 N. Wabash Ave., Suite 39300, Chicago, IL 60611-5885. 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. Sometimes, a large group can make scrolling thru a document unwieldy. When other reconstructive procedure(s) (skin graft, myocutaneous flap, vessel graft . Can I report 11042 (debridement skin and subcutaneous tissue, first 20 sq cm) and +11045 (each additional 20 sq cm) for the debridement in addition to the split thickness skin graft code? cm.). hbbd``b`J@ H0lV$ W0 y Note that debridement of the skin that is preparatory to further surgery, such as reduction of fracture, should not be coded as a separate procedure. Remember that the debridement codes, 11042-11047, are reported when you debride an open wound that will stay open to heal by secondary intention. In your case, the wound is being closed with a split thickness skin graft so the debridement codes are not accurate in this situation. Earn CEUs and the respect of your peers. 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. 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. 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. The AMA does not directly or indirectly practice medicine or dispense medical services. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. I work in an acute care center with a burn unit and . Should we drop Mods 59s and instead use XSs, for both 11042 and 11043? 2. Also, you can decide how often you want to get updates. not endorsed by the AHA or any of its affiliates. that coverage is not influenced by Bill Type and the article should be assumed to 15004 and +15005 for face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits endstream endobj startxref Before sharing sensitive information, make sure you're on a federal government site. End Users do not act for or on behalf of the CMS. In CPT, coding these grafts by size is a novel concept. Youll find the codes for skin substitute graft procedures in the range 15271-+15278 (Application of skin substitute graft ). Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Code 86.69 may be assigned twice, if desired, to show the repair of the leg ulcer.. If the documentation supports that 20 sq. THE UNITED STATES 0000010407 00000 n Response to Comment (RTC) articles list issues raised by external stakeholders during the Proposed LCD comment period. 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) The objective of the procedure is to . Local infiltration, metacarpal/digital block or topical anesthesia are included in the reimbursement for debridement services and are not separately payable. Reproduced with permission. . K;7@J3"(>6&/~!.]wWV~- *h"BQ"H" 5=QHpI8$ {Lz You can still separately code for deep debridement that includes muscle and bone, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington, using a code such as 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq. "2 2a TDl.Uae9c[yd\asU/(~8}ep an effective method to share Articles that Medicare contractors develop. Like the site preparation codes, CPT distinguishes these codes by anatomic site and wound surface area, as follows: 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. culture and sensitivity), osteomyelitis (e.g. Skin substitute grafts include the following: cm; we know that many times the actual size of the skin substitute is larger than the area that was covered. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. To report these codes, the surgeons documentation should demonstrate work such as removing nonviable tissue and/or releasing a scar contracture. Therefore, if a drug is self-administered by more than 50 percent of Medicare beneficiaries, the drug is excluded from coverage" and the MAC will make no payment for the drug. An asterisk (*) indicates a This method may require the surgeon to perform "staged" debridements as the wound heals. *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. Determining the wound location and surface area is important in order to select the appropriate CPT code. You need to master the different graft options and know how to find the information in the surgeons note, because CPT includes different code sets for each type of graft. Would also adding Mod 22 help, and for which one 11042 or 11043? Debridement Debridement of subcutaneous tissue (e.g., Current Procedural Terminology (CPT) codes 11042 and 11045, if appropriate) is considered Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Youre right about the skin graft code(s). 3. You are leaving the CMS MCD and are being redirected to the CMS MCD Archive that contains outdated (No Longer In Effect) Local Coverage Determinations and Articles, You are leaving the CMS MCD and are being redirected to, AMA CPT / ADA CDT / AHA NUBC Copyright Statement, Article - Billing and Coding: Debridement Services (A56617). CDT is a trademark of the ADA. cm. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSES Coding Rationale The physician excised a malignant lesion from the patient's lower leg followed by closure with a split-thickness graft. 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. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. The procedure is essential for wounds that aren . Tech & Innovation in Healthcare eNewsletter, Excision of Benign or Malignant Skin Lesion, Reporting Debridement Requires Documented Area and Depth, Both Depth and Area Matter when Reporting Debridement, Meet Documentation Criteria for Excisional Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) 11042, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed) 11043, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed) 11044. Contractors may specify Bill Types to help providers identify those Bill Types typically Unless specified in the article, services reported under other 0000012252 00000 n iii. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. In addition to the type of graft material, the surgeon should also document site preparation and wound size, and number and location of grafts, according to Beresh. 0000022753 00000 n Debridement services are now defined by body surface area of the debrided tissue and not by individual ulcers or wounds. 0000017393 00000 n 1. If more than 44-sq. Please reference the CPT descriptions for application of skin substitutes codes (Attachment C). If a simple dressing change is performed without any active wound procedure as described by these codes, do not bill these codes to describe the service. "JavaScript" disabled. Add skin substitute: When your surgeon performs a skin substitute graft, the supply of the skin substitute/ graft should be reported separately, according to CPT instruction. Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. Refer to NCCI and OPPS requirements prior to billing Medicare.For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.The diagnosis code(s) must best describe the patient's condition for which the service was performed. End User Point and Click Amendment: (See "Indications and Limitations of Coverage.") What does Separate Procedure Mean in a CPT Code Description? 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. Is this right? John Verhovshek, MA, CPC, is a contributing editor at AAPC. (application of skin substitute graft to, for example, leg or ankle). The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. Based on what I have read in the Official Guidelines for Coding and Reporting and Coding Clinic for ICD-9-CM, I believe that I should report two separate codes. DISCLOSED HEREIN. 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. 0000008118 00000 n At a minimum, the Progress Report must document the continuing skilled assessment of wound healing as it has progressed since the evaluation or last Progress Report. Do not report 11042 -11047 in conjunction with 97597-97602 for the . Any other conditions that may significantly affect wound healing should also be appropriately addressed in the medical record. Otherwise, the graft code would have an includes note indicating the debridement is inherent in the code. The American Hospital Association ("the AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. For example, debridement of two ulcers on the foot to the level of subcutaneous tissue, total area of 6 sq cm should be billed as CPT code 11042 with unit of service of "1". 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. Add together the surface area of multiple . Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. reasonable efforts to provide accurate coding information, this information should not be construed as providing clinical advice, dictating reimbursement policy, or substituting for the judgment of a practitioner. The skin substitute graft codes require some form of fixation, such as adhesives, sutures, or staples. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Thank you. that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes. These unique codes are classified as per the anatomic site (general and specific body areas) and size (wounds with a total surface area less than 100 sq. cm of the total 85.25 sq. 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