Debridement Codes "Excised" for 2011

December 27th, 2010

For 2011, the AMA has expanded the Integumentary System subsection to include new guidelines to define debridement.  The Excision and Debridement subsection (11000-11047) went through extensive changes.

The familiar codes 11040 and 11041 are gone.  In a parenthetical note under the codes' old location is a note reading, "For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598.” 

97597 and 97598 are wound care codes that require active wound care procedures to remove devitalized and/or necrotic tissue and promote healing.  97597 is for 20 square centimeters or less.  97598 is an add on code.  97598 is used in addition to 97597 for each additional 20 square centimeters or part thereof.  These codes are not to be used in addition to codes 11042 through 11047.

The documentation to support selective 97597 and 97598 should include the following:

  • Types of instruments used for selective debridement (i.e. high-pressure waterjet, scissors, scalpel, forceps);
  • Assessment of the wound including drainage, color, texture, temperature, vascularity, condition of surrounding tissue, and size of the area to be targeted for debridement.

If the provider treats with a nonselective method (such as a whirlpool) prior to using selective debridement, for the wound during the same visit, then only the selective debridement is reimbursable.  A modifier 59 should only be used 59 if two different wounds are treated with the different modalities.  Clearly note the location of each wound and the treatment associated with each wound.

CPT code 11042 has been revised to read “debridement, subcutaneous tissue (includes epidemis and dermis, if performed); first 20 square centimeters or less.”   Add on code 11045 is new and covers each additional 20 square centimeters of part thereof.

11043 is used for the first 20 square centimeters muscle and/or fascia.  11046 is the add on code for each additional 20 square centimeters of part thereof.

Note that the add on codes are frequently out of numerical order.

Debridement of burn wounds remain 16020-16030.


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