11043 CPT Code: Know Your Codes
11043 CPT Code Description: Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less.
Description of Procedure
11043 CPT Code: Inspect and document the ulceration for size, location, depth; classification/staging; and any interval changes, if appropriate, from any previous inspections. Anesthesia, as necessary, is utilized. The posterior heel ulcer bed is debrided, excising nonviable skin and subcutaneous tissue, if present, and tendon/muscle tissues with forceps, scissors, scalpel, or tissue nippers to the level of viable tissue. Hemostasis is obtained. The wound is inspected and irrigated. Upon completion, the ulcer is remeasured and the size recorded.
Debridement Codes (11042 – 11047)
Wound debridement codes (not associated with fractures) are reported with CPT codes 11042 – 11047. Wound debridements are reported by the depth of tissue that is removed and the surface area of the wound. These services may be reported for injuries, infections, wounds, and chronic ulcers. When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of the wounds that are at the same depth, but do not combine sums from different depths. These procedures require the use of forceps, scissors, scalpel, or tissue nippers. The codes are used when the wound is intended to heal by secondary intention.
The codes for excisional debridement are divided by the level of tissue removed and the size of the wound debrided. If the physician removes only subcutaneous tissue, coders would report CPT code 11042 for the first 20 sq cm and 11045 for each additional 20 sq cm. So if the physician documents removal of 65 sq cm of subcutaneous tissue, coders would report 11042 and 11045×3. For debridement of muscle or fascia, coders report 11043 CPT code for the first 20 sq cm and 11046 for every additional 20 sq cm. If the physician debrides a wound down to the bone, report 11044 for the first 20 sq cm and 11047 for each additional 20 sq cm. Note that the add-on codes for additional sq cm do not directly follow the codes for the first 20 sq cm.
Total Area Removed
- When coding multiple debridements on the same level, such as three subcutaneous debridements, coders should total the surface area debrided and select the appropriate codes.
- For example, a physician documents a 26 sq cm debridement to the muscle of the upper right arm, a 15 sq cm debridement to the muscle of the right shoulder, and a 16 sq cm debridement to the muscle of the lower right arm. The coder would add all three areas together for a total of 57 sq cm and report 11043 for the first 20 sq cm and 11046×2 for the remaining 37 sq cm.
- If the physician documents debridements to different levels at the same anatomical site, report only the deepest debridement. If the physician documents different levels of debridement at different anatomical sites, coders should report both debridements and append modifier 59 (distinct procedural service) to the shallower debridement.
- For example, the physician documents a 14 sq cm debridement to the bone on the patient’s left leg and a 35 sq cm subcutaneous debridement of the patient’s left arm. Coders would report 11044 for the left leg debridement and 11043-59 and 11046-59 for the left arm.
- Coders should look for documentation of the type of tissue removed and whether the wound is larger. This will help them decide whether to bill excisional codes or removal of nonviable tissue codes. For an excisional debridement, the post-debridement wound size should always be larger because the physician is removing living tissue.
Other Debridement Codes Description
11042 CPT code: Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less (For debridement of skin [i.e., epidermis and/or dermis only], see 97597, 97598)
+11045 CPT Code: 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) (Use 11045 in conjunction with 11042).
+11046 CPT code: 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) (Use 11046 in conjunction with 11043).
11044 CPT code: Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
+11047 CPT code: 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) (Use 11047 in conjunction with 11044)
Do not report codes 11042 – 11047 in conjunction with codes 97597 – 97602 for the same wound. For wounds that are being surgically excised in preparation for closure, refer to the 1500x codes.
Example of 11043 CPT Code
- A 74-year-old diabetic female with limited mobility presents with a 4.0 cm x 3.5 cm posterior heel ulceration involving the skin and subcutaneous tissues and Achilles tendon/muscle. She requires debridement of the wound, including debridement of the tendon/muscle.
- If there are multiple wounds from which you have debrided a different tissue type, lump all similar wounds (based on the type of tissue you have debrided) together. For example, if debriding bone from wound #1 (< 20 cm²), bill CPT 11044. If debriding muscle from wound #2 (<20 cm²), then also bill CPT 11043 -59 for the second wound since you are debriding different tissue. Append the lesser debridement code with the 59 modifier.
- On the other hand, if the above scenario includes debridement of bone from wound #1 (<20 cm²) and debridement of muscle from multiple wounds with an aggregate of 30 cm², billing would be CPT 11044 for wound #1 (<20 cm²) and CPT 11043-59 (for the first 20 cm²) along with CPT 11046 for the additional >20 cm2 debrided for the other combined similar wounds.
Wound Debridement Vs Active Wound Care Management
Surgical preparation codes (15002 – 15005) are intended to describe burn and wound preparation or incisional or excisional release of scar contracture resulting in an open wound requiring skin grafts. Surgical preparation codes relate to healing wounds by primary intention, whereas debridement and wound management codes relate to healing wounds by secondary intention. This is why CPT guidelines instruct the user to consider wound management codes (97597, 97598) and debridement codes (11042 – 11047) in cases in which nonviable tissue is removed from a chronic wound and it is left to heal by secondary intention, and to not report surgical preparation codes 15002 – 15005.
Wound care management and debridement CPT codes sets are meant for cases in which the healing of the wound is by secondary intention. Wound debridement codes are intended for acute wounds that are debrided of devitalized tissue, while active wound care management codes are intended for cleansing and promoting healing in chronic wounds. Debridement is measured in total depth and surface area, going from skin level down to the bone, while wound care management is limited to surface area only, generally does not go below skin level, and can be performed repeatedly as needed.
CPT © Copyright 2021 American Medical Association
We hope that this article has provided basic guidelines about the 11043 CPT code. If you are looking for overall billing and coding services you can refer to E2E Medical Billing Services. Our accurate and affordable billing services will eliminate billing and coding errors and will increase your practice collection. To know more about our medical billing and coding services, call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com