11044 CPT Code: Know Your Codes

October 6, 2020Wound Care

11044 CPT Code Description: Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less.

Description of Procedure (11044)

Inspect and palpate the surrounding skin, wound edge, and exposed soft tissue and bone. Document the size, location, drainage, and depth of the wound. Inspect for and document sinus tracts, undermining, odor, and the quality of the wound bed tissue. Anesthesia, as necessary, is utilized. Remove, with scalpel and forceps, scissors, ronjeur, or tissue nippers, the overhanging skin at the wound margins, the nonviable fatty tissue, and the exposed bone using the ronjeur, cutting it back to bleeding bone and deeper than the soft tissue. Send samples of the debrided bone for culture and/or histopathology. Copiously irrigate the wound bed. Ensure hemostasis of the wound bed.

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 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 CPT code 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 CPT code 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).

11043 CPT code: Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less.

+11046 CPT code: Debridement, muscle and/or fascia (includes the 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).

+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 11044 CPT Code

A young woman presents with multiple wounds from a rollerblading accident. She suffered a grossly contaminated open fracture-dislocation of the right thumb, and palmar surface injuries to the left hand and thigh. Her right-hand required debridement through the subcutaneous tissue, muscle fascia, and muscle of a 3 cm x 3 cm area with reduction and internal fixation. Her left-hand required debridement down to and including bone of a 3 cm x 2 cm area. Her left thigh required debridement down to and including bone of a 6 cm x 10 cm area. In this instance, reportable procedures are as follows:

• 26665, Open treatment of carpometacarpal fracture-dislocation, thumb, internal fixation
• 11011 – 51, Debridement open fracture and/ or an open dislocation; skin, subcutaneous tissue, muscle fascia, and muscle, right thumb
• 11044 – 51, Debridement, bone, first 20 sq cm, left hand and thigh
• +11047, Debridement, bone, each additional 20 sq cm, left hand and thigh
• +11047, Debridement, bone, each additional 20 sq cm, left hand and thigh
• +11047, Debridement, bone, each additional 20 sq cm, left hand and thigh

The procedure on her right-hand involved debridement of the epidermis and muscle with reduction and fixation. Open treatment of the dislocation is reported with the appropriate fracture code, in this case, 26665. Code 11011 is used to report debridement of an open fracture and/or dislocation of skin, subcutaneous tissue, muscle fascia, and muscle. The procedures on the left-hand involved debridement of the bone of a 6 sq cm area. The procedure on her left thigh also includes debridement of bone. Because the procedures on the hand and thigh are debrided to the same depths, the surface area of the wounds is summed. 11044 CPT code would be reported for the first 20 sq cm and add-on code 11047 would be reported three times for the second 20 sq cm, third 20 sq cm, and the remaining 6 sq cm of the 60 sq cm total wound surface.

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 the surface area only, generally does not go below skin level, and can be performed repeatedly as needed.

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