Tag Archives: wound debridement

How To Code – Wound Repair or Closure

Wound Repair or closure

Wound Types –

  1. Abrasion – skin scrapped off
  2. Laceration – ragged skin tear , crushed tissue
  3. Amputation – surgical removal of limb
  4. Incision – cut, wound from a sharp object
  5. Puncture – by penetrating or nailing object , by bullets
  6. Avulsion – tearing away of tissues from a body part

3 Factors to be considered while coding wound closure

  1. Length – length of wound (in cm)
  2. Complexity – complexity of repair
  3. Site – site of wound repair

Wound repair classification as per CPT manual

  • Simple Repair (12001 – 12021) –

    • Superficial wound repair or one layer closure.
    • Involves epidermis, dermis and subcutaneous tissue.
    • Require one layer suturing for closure
  • Intermediate Repair (12031- 12057)

    • One or more layers of subcutaneous tissue and superficial (non – muscle) fascia in addition of epidermis and dermis.
    • Simple closure of heavily contaminated wounds which requires extensive cleaning or removal of particulate matter also coded as intermediate closure
  • Complex Repair (13100 – 13160)

    • Involves complicated wound closure including revision, debridement, extensive undermining, stents or retention sutures.

 

Classification Site of Wound Length of Wound CPT Code
       
Simple repairs Scalp, neck, axillae, external genitalia, trunk, extremities including hands and feet 2.5 cm or less 12001
2.6 to 7.5 cm 12002
7.6 to 12.5 cm 12004
12.6 to 20.0 cm 12005
20.1 to 30.0 cm 12006
Over 30.0 cm 12007
Face, ears, eyelids, nose, lips, mucous membranes 2.5 cm or less 12011
2.6 to 5.0 cm 12013
5.1 to 7.5 cm 12014
7.6 to 12.5 cm 12015
12.6 to 20.0 cm 12016
20.1 to 30.0 cm 12017
Over 30.0 cm 12018
       
Intermediate Repair Scalp, axillae, trunk, extremities excluding hands and feet 2.5 cm or less 12031
  2.6 to 7.5 cm 12032
  7.6 to 12.5 cm 12034
  12.6 to 20.0 cm 12035
  20.1 to 30.0 cm 12036
  Over 30.0 cm 12037
Necks, hands, feet, external genitalia 2.5 cm or less 12041
  2.6 to 7.5 cm 12042
  7.6 to 12.5 cm 12044
  12.6 to 20.0 cm 12045
  20.1 to 30.0 cm 12046
  Over 30.0 cm 12047
Face, ears, eyelids, nose, lips and mucous membrane 2.5 cm or less 12051
  2.6 to 5.0 cm 12052
  5.1 to 7.5 cm 12053
  7.6 to 12.5 cm 12054
  12.6 to 20.0 cm 12055
  20.1 to 30.0 cm 12056
  Over 30.0 cm 12057
       
Complex Repair Trunk 1.1 to 2.5 cm 13100
  2.6 to 7.5 cm 13101
  Each additional 5 cm or less +13102
Scalp, arms, legs 1.1 to 2.5 cm 13120
  2.6 to 7.5 cm 13121
  Each additional 5 cm or less +13122
Forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, feet 1.1 to 2.5 cm 13131
  2.6 to 7.5 cm 13132
  Each additional 5 cm or less +13133
Eyelids, nose, ears, and lips 1.1 to 2.5 cm 13151
  2.6 to 7.5 cm 13152
  Each additional 5 cm or less +13153
       

 

Coding Rules: For multiple wounds

  • When more than one classification of wound repair are given (more than one repair type), code more complicated as primary and less complicated as secondary with modifier -59 (distinct procedural service).

 

Hierarchy is

 

  • Same classification –
    1. Wounds from Same group of anatomic sites – Combine the length of all wounds
    2. Wounds from different group of anatomic sites – Don’t combine, coded separately (greater length wound will be coded as primary)
  • For each anatomic site, the lengths of wounds are totaled together by complexity (simple, intermediate, complex ). For Example All the simple wounds of the same site grouping are reported together; all the intermediate wounds of the same site grouping are reported together; and all the complex wounds of the same site grouping are reported together.
  • Three things are considered components (parts) of integumentary wound repair:
    1. Simple ligation (tying) of small vessels is considered part of the wound repair and is not reported separately. Simple ligation of medium or major arteries in a wound is, however, reported separately.
    2. Simple exploration of surrounding tissue, nerves, vessels, and tendons is considered part of the wound repair process and is not listed separately.
    3. Normal debridement (cleaning and removing skin or tissue from the wound until normal, healthy tissue is exposed) is not listed separately.

How to Code – Debridement

Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound. The goal of debridement is to cleanse the wound, reduce bacterial contamination, and provide an optimal environment for wound healing or possible surgical intervention. The usual end point of debridement is removal of pathological tissue and/or foreign material until healthy tissue is exposed.

Techniques 

Debridement techniques include, among others, sharp and blunt dissection, curettement, scrubbing, and forceful irrigation. Surgical instruments may include a scrub brush, irrigation device, electrocautery, laser, sharp curette, forceps, scissors, burr, or scalpel Prior to debridement.

Debridement CPT Codes  : 11000 – 11047

  1. 11000 & 11001 – For Eczematous Debridement
  2. 11004 – 11006 – For debridement of Soft tissue infection(i.e. upto skin, subcutaneous tissue and muscle,fascia level)
  3. 11010 – 11012 – Excisional Debridement
  4. 11042 – 11047 – Wound Debridement

Excisional Debridement

defined as the “surgical removal or cutting away of devitalized tissue, necrosis, or slough,” which could be performed in the operating room, emergency room, or at the patient’s bedside.

Some surgical procedure codes include debridement as a part of the service. You may report a debridement as a separate service when the medical record indicates that a greater than usual debridement was provided. For example, if an extensive debridement of an open fracture was performed when usually a simple debridement would be performed, you report the additional service using a debridement code from the 11010-11012 range.

Divided according to location:

11010 – skin and subcutaneous level

11011 – Muscle , Fascia level

11012 – Bone level

Wound Debridement

11042 – 11047 – Wound Debridement

Divided according to – Depth of tissue –

11042 – skin and subcutaneous level

11043 – Muscle , Fascia level

11044 – Bone level

Diveded according to Surface Area –

11042,11043,11044 – upto 20 sq cm

11045, 11046 – More than 20 Sq cm

Coding tips –  When reporting one wound, report the depth of the deepest level of tissue removed. When reporting multiple wounds, sum the surface area of the wound at the same depth. Do not combine sums of different depths.

Other Important Points to Remember while coding for debridement

  1. These debridement codes do not apply to debridement of burned surfaces. For debridement of burned surfaces, CPT codes 16000-16036 are reported.
  2. Do not assign additional codes for debridement when these procedures are an integral part of the total procedure performed. A debridement carried out in conjunction with another procedure is often, but not always, included in the code for the procedure.
  3. Do not use these codes for pressure ulcers, for Pressure ulcers – code 15920-15999