Auto- is different: If you see the term autograft or tissue cultured autograft, then you are dealing with the harvest and/or application of an autologous skin graft. I work in an acute care center with a burn unit and . CPT considers debridement a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure. cm of the total 85.25 sq. Distinguish the codes based on body site, as follows: Each pair of codes identifies the size of the defect created by the surgical preparation, with the first code (15002 or 15004) describing the first 100 sq cm for adults and children aged 10 and up, or 1 percent of body surface area for children under 10 years of age, including infants. A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette) authorized with an express license from the American Hospital Association. The Current Procedural Terminology guidelines state that debridement is considered a separate procedure "when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure." Complete documentation for excisional debridement requires five elements, including: i. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom Federal government websites often end in .gov or .mil. preparation of this material, or the analysis of information provided in the material. 463 Wound Debridement & Skin Graft Except Hand, for Musculo-Connective Disorders w/ MCC 8 Diseases and Disorders of the . Identification of the wound location, size, depth and stage either by description and/or a drawing or photograph. Autologous skin grafts are those that the surgeon harvests from another healthy part of the patients own body, and you would use different codes for those graft procedures. That means you should never report 97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) in addition to skin graft site preparation codes. The AMA is a third party beneficiary to this Agreement. When subcutaneous tissue is debrided from a 16 s. cm dehisced abdominal wound and a 10 sq cm thigh wound, report 11042 for the first 20 sq cm and 11045 for the second 6 sq cm. 2021 Evaluation and Management Codes: Is a History Required? Instead, report 15273 and 15274 for the application of skin grafts of the arm, and codes 15277 and 15278 for application of skin grafts of the hands and fingers. not endorsed by the AHA or any of its affiliates. . These unique codes are classified as per the anatomic site (general and specific body areas) and size (wounds with a total surface area less than 100 sq. The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.) hb```f``e`2jx Y8t00:00@9@ 6 jx copied without the express written consent of the AHA. Bottom line: Accurately coding skin substitute grafts requires lots of specific information in the medical record. 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC 573 Skin Graft for Skin Ulcer or Cellulitis with MCC The document is broken into multiple sections. Remember that the debridement codes, 11042-11047, are reported when you debride an open wound that will stay open to heal by secondary intention. Answer: No. Thank you. Some articles contain a large number of codes. CPT codes 11000 and 11001 describe removal of extensive eczematous or infected skin. The views and/or positions presented in the material do not necessarily represent the views of the AHA. I work in an acute care center with a burn unit and have been striving for accuracy and consistency. of every MCD page. Supplies such as A6453 (Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard) are included in the skin application charge. required field. When the patient has required more debridement services per wound than defined below, the medical record must include documentation reflecting neuropathic, vascular, metabolic, or other comorbid conditions. You need to master the different graft options and know how to find the information in the surgeons note, because CPT includes different code sets for each type of graft. Reduction of pressure and/or control of infection will facilitate healing and may reduce the need for repeated debridement services. You can still separately code for deep debridement that includes muscle and bone, says Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington, using a code such as 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq. 0 j0 W0 43 32 Face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/ or multiple digits While every effort has been made to provide accurate and A determination of the initial treatment plan to include the expected frequency and duration of the skilled treatment and the potential to heal. The patient's medical record must contain documentation that fully supports the medical necessity for services included withinthe related LCD. Not exactly. Include dressing: You might find documentation of wound dressing in the op report for skin substitute grafts, but you shouldnt separately code routine dressing supplies for services performed in the office, according to CPT instruction. Draft articles are articles written in support of a Proposed LCD. In most instances Revenue Codes are purely advisory. For example, debridement of two ulcers on the foot to the level of subcutaneous tissue, total area of 6 sq cm should be billed as CPT code 11042 with unit of service of 1. 0000002443 00000 n He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. Non-human skin substitute grafts such as xenografts (from another animal such as pig) Privacy Policy | Terms & Conditions | Contact Us. %%EOF Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. For purpose of this exclusion, "the term 'usually' means more than 50 percent of the time for all Medicare beneficiaries who use the drug. Question: Codes 15002-15005 apply specifically to describe the work of "preparing a clean and viable wound surface for placement of an autograft, flap, skin substitute graft or for negative pressure wound therapy," according to CPT guidelines. HWAnl))1p9CK,q@:(#"ET.OSnt$v\^lt6btT 9A'w>$bg71w= Y)s.girVu^T_N'%u7Ag>f|vsQ lCN}uCjdgIKLYvO0>E,bRpUuCXX_"RkdEN""/@1] $' O*o5-OEJmq@Hc^VVl 0 cm and then debridement codes (with an appropriate modifier) for the remaining 65 sq. Question: 465 Wound Debridement and Skin Graft Except Hand, for Musculo-Connective Tissue Disorders without CC/MCC 5. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 1309 0 obj <>stream Report 97597 for ulcer debridement down to the subcutaneous tissue. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. U.+"x/J>DcB 3]HE1}}&Z\d3aD)6C~NYZgois\t-w;s3N>dgp@GtBisMaq)%le"Z\g.j4 9qEb*NLaQD\/z a\)DC|[JkHHq\J.d&X. Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. o Total site 100 sq cm or more: 15273 first 100 sq cm (or 1 percent body area infants and children); +15274 each additional 100 sq cm (or 1 percent body area infants and children), o Similar code pairs based on area: 15275 and +15276; 15277 and +15278. CMS and its products and services are not endorsed by the AHA or any of its affiliates. If infection has developed, the patient's response to this infection should be described. Non-excisional debridement (e.g., 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session) is described as nonsurgical because it does not involve cutting away or excising devitalized tissue. Non-graft wound dressings or injected skin substitute codes are not used with skin replacement surgery application codes and are considered incorrect coding. If you do not agree with all terms and conditions set forth herein, click below on the button labeled "I do not accept" and exit from this computer screen. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Many claims for debridement are essentially dressing changes and are not separately payable. iv. By clicking below on the button labeled "I accept", you hereby acknowledge that you have read, understood and agreed to all terms and conditions set forth in this agreement. If all four wounds were debrided on the same day, apply modifier 59 Distinct procedural service with either 11042 or 11044, as appropriate. If any of these elements is missing, documentation does not meet the criteria for excisional debridement. Size: To determine the surface area for code selection, add all areas within the same anatomic grouping, if the surgeon prepares multiple wounds. If the provider is unable to use photographs for documentation purposes, the medical record should contain sufficient detail to determine the extent of the wound and the result of the treatment. Peruse CPTs Skin Replacement Surgery section, and youll see that the guidelines mention different types of skin grafts. Addition to Skin Graft Codes 15271-15278 is the new CPT code series for skin substitute grafts. used to report this service. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. Debridement is the removal of dead (necrotic) or infected skin tissue to help a wound heal. 15002 and +15003 for trunk, arms, legs (including wrist or ankle) hbbd``b`J@ H0lV$ W0 y a$EdK@#)6e|y~#5H. complete information, CMS does not guarantee that there are no errors in the information displayed on this web site. v. The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue, muscle, or bone). This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

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