Wound debridement, wound repairs, and skin replacement surgery are among several procedures in the integumentary system subsection of the CPT® Manual for which there are new guidelines in 2012. Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC, director of education at the AAPC in Salt Lake City, provided an overview of the changes and explained what coders and physicians should keep in mind.
Wound debridement (11042-11047) is always a tricky area of coding because it requires explicit physician documentation of the following:
- Depth of the tissue removed
- Surface area of the wound
In general, physicians receive greater reimbursement for debridement of larger and deeper wounds, which is why accurate documentation—and subsequent code assignment—is crucial.
New guidelines for 2012 remind coders that when physicians debride a single wound, they should report depth using the deepest level of tissue removed. For example, if a physician debrides a wound down through the fascia and into the bone, coders should report a code for a wound debrided into the bone. This includes debridement of the fascia.
Be careful when reporting debridement of multiple wounds, however. When physicians debride multiple wounds of the same depth, report one code that includes a summation of the surface area of those wounds. For example, when a physician debrides bone from a 10 square centimeter heel ulcer as well as an 8 square centimeter ischial ulcer, report 11044 (debridement, bone [includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed]; first 20 square centimeters or less. This code denotes the depth of the wound (i.e., into the bone) as well as the summation of the surface area both wounds (i.e., 10 square centimeters + 8 square centimeters).
However, when physicians debride multiple wounds of different depths, do not sum the surface area of those wounds. For example, a physician debrides subcutaneous tissue from a 10 square centimeter heel wound and bone from a 5 square centimeter thigh wound. Do not sum the total surface area because the depth of each wound differs. Instead, report 11042 and 11044.
New CPT guidelines for wound repairs state coders should report modifier -59 (distinct procedural service) when physicians repair more than one classification of wounds. Coders should list the more complicated repair as the primary procedure followed by the less complicated repair as the secondary procedure. They should append modifier -59 to the less complicated procedure.
For example, a physician performs a simple repair of a 2.6 cm wound on the neck as well as an intermediate repair of a 2.7 wound on the scalp. Coders should report 12032 followed by 12002-59.
Prior to 2012, coders reported modifier -51 (multiple procedures) to distinguish between different classifications of wound repairs. Like modifier -51, modifier -59 is important because it may help override certain payer systems that normally bundle these services. Reporting the modifier will ensure correct payment for these services.
Skin replacement surgery
New CPT guidelines remind coders that in general, skin replacement surgery includes surgical preparation (15002-15005) as well as the topical placement of either an autograft/tissue cultured autograft (15040-15261) or a skin substitute graft (15271-15278). CPT provides detailed definitions for each type of graft as well as an explanation of how physicians surgically prepare a clean and viable wound surface. These definitions and explanations can assist coders in reviewing physician documentation to better understand surgical procedures and ensure correct code assignment.
New codes for skin substitute grafts are also more simplified. Previously, codes for skin substitute grafts distinguished between specific types of skin substitute (e.g., allograft, acellular dermal allograft, and tissue-cultured allogeneic dermal substitute). As of 2012, these more specific codes were deleted and replaced with new codes based on anatomic site and size. Coders are no longer required to specify the type of skin substitute. Coders should remember to separately report a HCPCS code for the supply of the skin substitute in conjunction with a code from the 15271-15278 range.
As always, coders should encourage physicians to document as thoroughly as possible to ensure compliant coding and accurate reimbursement. Physicians should document the following information for skin replacement surgery:
- Anatomic site
- Type of graft (autograft vs. skin substitute)
- Size of the graft
Lisa A. Eramo is a freelance writer and editor specializing in medical coding, health information management, and other healthcare regulatory topics. Visit her website at http://lisaeramo.wordpress.com/.
For additional information on 2012 CPT code changes, read our recent articles Getting Paid in 2012: 2012 CPT Code Changes and More, CPT Changes for 2012: An Overview, 2012 CPT Code Changes: Reporting Procedures Related to Pacemakers and Cardioverter-Defibrillators, 2012 CPT Code Changes: Billing Prolonged Services, Part I and 2012 CPT Code Changes: Billing Prolonged Services, Part II.