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Thousand Cranes » Blog Archive » Proper Use of CPT Codes 11040-11044: Debridement of Skin

 
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Proper Use of CPT Codes 11040-11044: Debridement of Skin
November 18th, 2008 by Anna

Proper Use of CPT Codes 11040-11044: Debridement of Skin

Contractor: Noridian Administrative Services (NAS)

Contractor Type: Medicare Part B, Arizona Jurisdiction

Effective for services performed on or after 10/01/2008

CPT Codes 11040 – 11044 are used to describe debridement of the skin for treatment of skin ulcers, circumscribed dermal infections, conditions affecting continuous deeper structures and debridement of ground-in dirt from road abrasions. Medicare considers an ulcer to have formed once there is a partial thickness skin loss involving epidermis with or without dermis. The different CPT Codes 11040-11044 describe the levels of tissue debridement of independent skin or tissue structures, therefore separate debridement codes may be used if debridement is necessary for an extended area of concurrent tissue damage (note that these codes do not include debridement of tissue with open fractures or dislocations. See CPT Codes 11010-11012).

11040 Debridement; Skin, Partial Thickness

11041 Debridement; Skin, Full Thickness

11042 Debridement; Skin, and Subcutaneous Tissue

11043 Debridement; Skin, Subcutaneous Tissue, and Muscle

11044 Debridement; Skin, Subcutaneous Tissue, Muscle and Bone

NAS will reimburse a total of four independent tissue debridements per date of service, regardless of whether the services were preformed on one or both feet. NAS will deny a claim submission with more than four tissue debridements. An appeal may be filed with documentation supporting the need for more than four services.

Modifiers

The following modifiers must be used to describe specific digits involved in the debridement (if any):

TA Left foot, great toe T5, Right foot, great toe

T1 Left Foot, second digit T6, Right foot, second digit

T2Left Foot, third digit T7, Right foot, third digit

T3 Left Foot, fourth digit T8, Right foot, fourth digit

T4 Left Foot, fifth digit T9, Right foot, fifth digit

If higher specificity is not applicable, modifier LT (left foot) and RT (right foot) may be used to describe location. Modifier 59 may also be used to describe an independent anatomical site.  Use this modifier ONLY if there are no other modifiers describing the area where debridement was performed.

Medical Necessity

CPT Codes 11040-11044 will only be paid if medical necessity is documented. Diagnosis must include at least ONE of the following ICD-9-CM Codes for claim to be paid.

250.80

707.03

707.8

879.3

884.1

250.81

707.04

785.4

879.5

885.1

250.82

707.05

872.10

879.7

886.1

250.83

707.06

872.11

879.9

887.1

440.23

707.07

872.12

880.10

887.3

440.24

707.09

875.1

880.11

887.5

454.0

707.10

876.1

880.12

887.7

454.2

707.11

877.1

880.13

890.1

681.10

707.12

878.1

880.19

891.1

681.11

707.13

878.3

881.10

892.1

682.7

707.14

878.5

881.11

893.1

686.8

707.15

878.7

881.12

894.1

686.9

707.19

878.9

882.1

919.3

707.00

707.22

879.1

883.1

707.01

707.23

707.02

707.24

Documentation Requirements

The clinical record must document:

  • Indications for debridement
  • Size
  • Location
  • Observed depth of ulcer(s)
  • Specific depth/level of debridement

There must also be documentation of relevant history and physical findings that justify the diagnoses and procedures claimed. Specific anatomical site(s) of services performed must also be included in the record.  Thousand Cranes suggests also documenting whether anesthesia was used, what type (local or general) if it was used, or the reasons it was not used.

CPT codes, descriptions and other data only are copyright 2008 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

References:

Medicare Part B LCD L24374


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