The most appropriate code for the given scenario would be:
Ref: CPT Assistant October 2007
How do we code primary surgical debridement of the Achilles tendon? The operative report says the tendon is chronically infected following a prior tendon reconstruction. Nonviable and necrotic portions were debrided and old suture material removed. Is it appropriate to report CPT code 11043, Debridement; skin, subcutaneous tissue, and muscle?
From a CPT coding perspective and as stated in Principles of CPT Coding 4th Edition, page 126: "Debridement is defined by Stedman's Medical Dictionary, 27th edition, as 'excision of devitalized tissue and foreign matter from a wound." The debridement codes in the CPT codebook are intended to be reported for surgical debridement with the exact surgical techniques chosen at the discretion of the physician.
The goal of debridement is to remove all foreign bodies and nonviable tissue, reduce the bacterial content in the wound, and maximally preserve viable tissue.
Debridement or repeated debridement procedures may be required depending on the degree of tissue damage; the fracture severity; the amount of dead and foreign material in the wound(s); and the amount of possible threat to surrounding neurovascular structures, ligaments, and tendons.
CPT codes 11040-11044 describe debridement of skin. The choice of the appropriate code will depend on the level of debridement performed. Some examples for the use of these codes include stasis ulcers, superficial infected wounds, avascular necrotic tissue, and gangrene.
Because nonviable and necrotic portions of the Achilles tendon were debrided, it would be appropriate to report code 11043. If, in addition to the debridement the surgeon performed a tenolysis of the Achilles tendon, it would also be appropriate to report code 27680, Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon. Additionally, modifier 59, Distinct procedural service, should be appended to indicate that the procedure was distinct from other services performed on the same day.
Although, the CPT guidelines do not restrict the number of times the debridement codes (eg, 11040-11044) can be reported in a given timeframe, third-party payers may have specific reporting guidelines such as the use of specific modifiers (eg, modifier 78, Return to the operating room for a related procedure during the postoperative period) to indicate that the patient received additional services during the postoperative period. Therefore, you may wish to contact your local third-party payer to determine its specific reporting requirements. Also, note that the use of the code is only appropriate where actual further debridement occurs as described (in the case of 11043, of actual skin, subcutaneous tissue and muscle), and not merely wound cleansing of the area where these elements were previously debrided.
Lastly, it is important for the surgeon to accurately describe in detail the depth of the debridement as well as the approximate dimensions and the structures involved so that the appropriate coding level can be assigned. This is one of the targeted areas for the Office of Inspector General (OIG) at the Centers for Medicare and Medicaid Services (CMS).
CPT Assistant, February 1997
Debridement of Multiple Sites
To report debridement of multiple sites, CPT codes 11040-11044 may be used more than one time, for a single patient encounter. For each site, select the appropriate code based on the intensity of the wound.
When reporting debridement of more than one site, the physician reports the secondary code (ie, the second code listed) with the -59 modifier appended, to indicate the different areas that were given attention.
11040Debridement; skin, partial thickness
11041skin, full thickness
11042skin, and subcutaneous tissue
11043skin, subcutaneous tissue, and muscle
11044skin, subcutaneous tissue, muscle, and bone
The following vignette illustrates the appropriate application of the CPT code(s) indicated. It is important to note that the vignette represents only the typical patient and service/procedure. Third-party payor reporting practices may differ.
A patient is recovering from a high voltage electric burn injury three weeks prior. He presents to physician's office for debridement of injuries to palmar surface of both hands and plantar surface of right foot.
The right hand injury involves debridement of necrosed tissue through the subcutaneous. Left hand injury is less intense and wound cleaning involves only minimal erythematous epidermis. The injury to the right foot shows minimal healing and debridement is carried out through the flexor digitorum brevis.