Coding guidelines for Debridement, Incision & Drainage, Biopsy

What are the coding guidelines for Debridement procedure 

Definition of debridement

Debridement is the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed

Codes describing based on the depth

There are three types of depth in code category

•     Subcutaneous tissue (includes epidermis and dermis, if performed) 11042  and 11045 
•     Muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed) 11043 and 11046
•   Bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed) 11044 and 11047

 Documentation for Debridement

1.       Excision
2.       instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette)
3.       Issue removed (e.g., necrotic, devitalized or non-viable)
4.       The appearance and size of the wound (e.g., down to fresh bleeding tissue, 7 cm x 10 cm, etc.)
5.        The depth of the debridement (e.g., to skin, fascia, subcutaneous tissue, muscle, or bone

Coding guidelines   

•      Intermediate, complex, or reconstructive repair if performed after a debridement can be coded separately with 51 modifier.

•      Debridement for Fracture and reduction codes are 11010, 11011, 11012. If it is extensively derided can be Coded  both fx and debridement with 51 modifier  

•      Other than Fx and reduction code 11042-11047.

•      Not involving subcutaneous tissue 97597(first 20 sq cm) and 97598 (each cm). May include scalpel, scissors, waterjet

•      Debridement of a single wound, report depth using the deepest level of tissue removed.

•      In multiple wounds, sum the surface area of those wounds that are at the same depth,

•      Should not combine sums from different depths

•      Use Multiple Codes When Different Tissue Depths Are Debrided on Different Wounds

Exmple: 1. Bone is derided from a 6 sq cm heel ulcer. This is reported with a single code, 11044
2.  for the debridement of an 8 sq cm wound on the right hand, 20 sq cm wound on the left thigh, and a 10 sq cm wound on right leg that all include subcutaneous tissue and muscle, code as follows: 11043, 11046

Accurate Coding guidelines for Incision and Drainage

 Incision and Drainage coding guidelines

Definition

Incision and drainage services, as related to the integumentary system, generally involve cutaneous or subcutaneous drainage of cysts, pustules, infections, hematomas, abscesses, seromas, or fluid collections. 

When do not code I&D:

• Incision and drainage shall not be reported separately with other procedures such as excision, repair, destruction, removal, etc., when performed at the same anatomic site at the same patient encounter.
• If it is I&D to access the area to performed other more extensive procedure it is not separately reportable.

Different between Simple VS complicated : I&D

Simple:

Single or simple. Without any packing.

Complicated:

• Multiple infection
• Packing with Gauze
• Drain placements
• Probing to break up loculations
• Extensive packing or
• Subsequent wound closure

Incision and drainage services, as related to the integumentary system, generally involve cutaneous or subcutaneous drainage of cysts, pustules, infections, hematomas, abscesses,
seromas, or fluid collections.

If it is necessary to incise and/or drain a lesion as part of another procedure or to gain access to an area for another procedure, the incision and/or drainage is not separately reportable if
performed at the same patient encounter

For example, a physician excising pilonidal cysts and/or sinuses (CPT codes 11770-11772) may
incise and drain one or more of the cysts. It is inappropriate to report CPT codes 10080 or 10081 separately for the incision and drainage of the pilonidal cyst(s).

HCPCS/CPT codes for incision and drainage shall not be reported separately with other
procedures such as excision, repair, destruction, removal, etc., when performed at the same
anatomic site at the same patient encounter.
HCPCS/CPT codes describing complications of a procedure may or may not be separately
reportable at the same patient encounter as the procedure causing the complication.

CPT code 10180 (Incision and drainage, complex, postoperative wound infection) would never
be reportable for the same patient encounter as the procedure causing the postoperative infection.

It may be separately reportable with a subsequent procedure, depending upon the circumstances.

If it is performed to gain access to an anatomic region for another procedure, CPT code 10180 is
not separately reportable. However, if the procedure described by CPT code 10180 is performed
at an anatomic site unrelated to another procedure, it may be reported separately with the
procedure

Skin Biopsy coding guidelines

1. Biopsy May not be reported with more extensive procedure (Eg: removal of lesion) when biopsy performed in same lesion at same at the same patient encounter. 11102-11107
2. May be reported with more extensive procedure when biopsy performed in different lesion. Can be coded with both codes with 59/XS modifier.