CPT Codes 11042, 11043, 11044, 97597, 97602: Tissue debridement wound care (2023)

Procedure Code and Description

11042- Debridement, subcutaneous tissue (including epidermis and dermis, if performed); first 20 cm square or less. – medium fee payment – ​​$120 – $130

11045(additional code for 11042) all or part of an additional 20 square centimeters.

11043debridement, muscle and/or fascia (including epidermis, dermis and subcutaneous tissue if performed); first 20 cm square or less.

11046(additional code for 11043) all or part of additional 20 square centimeters.

11044Bone debridement (including epidermis, dermis, subcutaneous tissue, muscle and/or fascia if performed); first 20 cm square or less. Procedure +11047 (additional code to 11044) for each additional 20 square centimeters or part thereof.


97597 DEBRIDATION (e.g. HIGH-PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDATION WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND (e.g. FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUD, RESIDUES, BIOFILM), INCLUDING TOPICAL APPLICATIONS) , WOUND ASSESSMENT, SWIMMING POOL USE, TIMING AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION, TOTAL WOUND SURFACE SURFACE; FIRST 20 SQUARE INCHES OR LESS

Tissue repair and transfer

The CPT Handbook classifies repairs (closure) (CPT codes 12001-13160) as simple, moderate or complex. If closure cannot be completed using either of these procedures, reassignment or transfer of adjacent tissue may be used (CPT codes 14000-14350). Adjacent tissue transfer or rearrangement procedures include excision (CPT codes 11400-11646) and repair (12001-13160). Therefore, CPT codes 11400-11646 and 12001-13160 should not be reported separately with CPT codes 14000-14350 for the same violation or
Wound.

In addition, the debridement required to perform a tissue transfer procedure is included in the procedure. It is inappropriate to report debridement (eg, CPT codes 11000, 11042-11047, 97597, 97598) with adjacent tissue transfer (eg, CPT codes 14000-14350) for the same lesion/injury.

Skin grafts associated with an adjacent tissue transfer or adjacent tissue repair must be reported separately if the graft is not included in the adjacent tissue transfer code descriptor code.

Adjacent tissue transfer codes should not be reported with a traumatic wound closure if the injury happens to be approximated with a tissue transfer closure (e.g., Z-Plastic, W-Plastic). The closure must be reported with repair codes. However, if the surgeon is performing a specific tissue transfer to close a traumatic wound, a tissue transfer code can be entered.

Collection of cultures or tissue samples during an occlusion is included in adjacent tissue repair or transfer codes and is not reported separately.

I. Grafts and valves

CPT codes describing skin grafts and skin substitutes are classified by size, location of defect in the recipient area, and type of graft or skin substitute. There are two or three CPT codes for most combinations of skin graft/skin substitute site and type, including a main code and one or two subsidiary codes. The primary code describes a skin graft/spare size and must not be reported with more than one service unit.

Larger grafts or skin replacements are reported with additional codes.

Primary skin graft/substitute codes (e.g. 15100, 15120, 15200, 15220) are mutually exclusive as only one type of skin graft/substitute can be used at an anatomical site. Where different types of skin grafts/substitutes are required at multiple sites, the different skin graft/substitute CPT codes should be specified with anatomical modifiers or modifier 59 to indicate the different sites.

Simple debridement of a skin wound (CPT codes 11000, 11042-11045, 97597, 97598) prior to skin grafting/skin replacement is included in the skin grafting/skin replacement procedure (CPT codes 15050-15431) and does not need to be reported separately. Where open wounds, burns or scars need to be removed at the recipient site, or where a scar contracture needs to be released by incision, CPT codes 15002-15005 may be reported separately for specific types of skin grafts/skin substitutes.

1. A CPT Manual statement following CPT code 67911 (correction of eyelid retraction) states that autograft CPT codes (20920, 20922 or 20926) may be reported separately. All other services required to complete the process are included.

Cover Advisor

Coverage indications, limitations and/or medical necessity

Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound. Debridement promotes wound healing by reducing sources of infection and other mechanical obstacles to healing.

Debridement services are considered medically useful and necessary when they are intended to treat wounds and ulcers of the skin and underlying tissues to promote optimal wound healing or to prepare sites for appropriate surgical intervention. The requirements for adequate and necessary services include the most appropriate safe and effective methods of debridement for the type of wound, provided in the appropriate environment and ordered and/or performed by qualified personnel.

For the purposes of this MDC, wound care is defined as the treatment of wounds that do not heal or have complicated healing cycles due to the nature of the wound itself or metabolic and/or physiological factors. Excluded from this definition are the treatment of acute wounds, the care of wounds that normally heal by primary intention, such as general.

This policy does not apply to equivalent/replacement dressings for metabolically active human skin, burns, skin cancer, or hyperbaric oxygen therapy.

WOUND CARE should include comprehensive wound care that includes appropriate management of aggravating factors such as unrelieved pressure, infection, uncontrolled vascular and/or metabolic disorders, and/or malnutrition, in addition to appropriate debridement.

Continued WOUND CARE Medicare coverage for a specific wound in a patient requires documentation in the patient's medical record that the wound is improving in response to the WOUND CARE provided. It is not medically advisable or necessary to continue a certain type of WOUND CARE if there are no signs of wound improvement.

Evidence of improvement includes measurable changes (decreases) in any of the following:

Drainage (color, amount, consistency)
inflammation
swelling
Dor
Wound dimensions (diameter, depth, tunneling)
necrotic tissue/scab

These proofs must be documented for each performance date. A wound that does not improve after 30 days requires a new approach, which may include medical reassessment of the underlying infection, metabolic, nutritional, or vascular problems that are inhibiting wound healing, or new treatment.

Debridement is defined as 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. This LCD is used for debridement of localized areas such as wounds and ulcers. It does not apply to the removal of infected or extensive eczematous skin.

Debridement of the wound(s), if indicated, should be performed with caution and at appropriate intervals. Medicare assumes that with proper care, wound volume or surface area will decrease by at least 10% per month, or that wounds will advance no less than 1mm per week. Medicare expects to change the wound care plan if adequate healing is not achieved.

Surgical debridement is the extensive excision or resection of all dead or devitalized tissue, possibly including excision of the viable wound margin. This is usually done in the operating room under anesthesia by a surgeon. It is often used for deep tissue infections, drainage of abscesses or affected tendon sheaths, or bone debridement.

Acute debridement is the removal of dead or foreign material just above the level of viable tissue and is performed in the office or at the patient's side with or without local anesthesia. Acute debridement is less aggressive than surgical debridement but has the advantage of rapidly improving wound healing conditions. Typically, these are recurring, superficial, or repeated wound care services.

Blunt debridement is the removal of necrotic tissue by cleaning, scraping, application of chemicals, or wet-dry dressing techniques. It may also involve cleaning and dressing minor or superficial wounds. This is generally not a specialized service and does not require the skills of a therapist, nurse, wound nurse or Wound Continence Ostomy Nurse (WOCN).

Enzymatic debridement is topical enzyme debridement used when the necrotic substances to be removed from a wound are proteins, fibers and collagen. The manufacturer's product insert contains indications, contraindications, precautions, dosage and administration guidelines. It is the physician's responsibility to adhere to these guidelines.

At least ONE of the following conditions must be present and documented:
bedsores, stage III or IV,

ulcers due to venous or arterial insufficiency,

wounds deescentes,

wounds with hardware or exposed bone,

neuropathic Geschwüre,

Complications of traumatic or surgically created wounds that require accelerated granulation therapy that cannot be achieved with other available topical wound treatments.

Selective debridement refers to the removal of targeted areas of dead or necrotic tissue from a wound along the margin of viable tissue. Occasional bleeding and pain may occur. Routine use of a topical or local anesthetic does not elevate active wound management to surgical debridement. Selective debridement involves the selective removal of necrotic tissue by sharp dissection using scissors, scalpel, and forceps; and selective removal of necrotic tissue by high pressure water jet. Selective debridement should only be performed when specifically directed by a physician.

High Pressure Water Jet/Pulsed Washing: (non-immersion hydrotherapy) is a pulsating or non-pulsing irrigating device used to deliver a jet of water to create a cutting effect to loosen debris in a wound. Some electrically pulsed irrigators include suction to remove debris from the wound after irrigation.

Debridement is used in the treatment and treatment of wounds or ulcers of the skin and underlying tissues. Providers should select the most appropriate debridement method for the type of wound, the amount of devitalized tissue and the patient's condition, the environment, and the provider's experience.

Debridement of the wound(s), if indicated, should be performed with caution and at appropriate intervals. With proper care, the wound volume or surface area should decrease once the size and depth of involvement and the extent of undermining have been established. Intermediate results should be drawn up for the wound. These short-term goals help the clinician identify wound improvement and serve to confirm the patient's wound healing response. Medicare expects to change the wound care plan if adequate healing is not achieved.

Original debridements are usually true surgical debridements. Repeated debridement is not the same achievement as the original debridement. However, once the initial muscle and/or bone debridement has been performed, there is usually no true necrotic muscle or bone. Subsequent surgical debridement of muscles or bones is usually not required. If the clinical history reveals complicating factors that contribute to further muscle or bone necrosis, subsequent surgical debridement of the muscle and/or bone may be deemed necessary. The medical history should indicate the complicating factors and the medical treatment used to manage these complications. The stepwise debridement of muscle and/or bone in two additional debridements should raise the question of whether complicating factors are adequately controlled. Additional muscle and/or bone debridement may not be warranted if the underlying condition(s) giving rise to the complicating factors (i.e., infection, abscess, vascular insufficiency, nutritional compromise, etc.) are adequately managed.

Just because a stage IV pressure ulcer is present does not necessarily mean that the additional debridements are bone and/or muscle debridements. The issue of charging for debridement services is not the stage of the wound; is what procedure is actually executed. A stage III or IV pressure ulcer must be billed using the CPT code that describes the service provided.

Electrical stimulation and electromagnetic therapy

Treatment of stage III and IV chronic pressure ulcers, arterial ulcers, diabetic ulcers, and venous stasis ulcers with electrical stimulation (ES) or electromagnetic therapy (ET) is subject to the limitations outlined in the CMS (NCD) National Pub 100 regulation - 03 Coverage, Chapter 1: Determining Coverage, Part 4, Section 270.1: Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds. Medicare does not expect ES/ET to be used as an initial treatment modality. The use of ES/ET will only be adopted as part of a therapy regimen when standard wound therapy has been attempted for at least 30 days and there is no measurable evidence of healing. Standard wound care includes: optimization of nutritional status, debridement by any means to remove devitalized tissue, maintenance of a clean, moist granulation tissue bed with appropriate moist dressings, and treatment necessary to eliminate any infection that may be present. Standard wound care based on the specific wound type includes: frequent repositioning of a pressure ulcer patient (usually every 2 hours), relieving pressure and good glucose control in diabetic ulcers, establishing adequate perfusion in arterial ulcers, and use of a compression system for patients with venous ulcers. Chronic ulcers are defined as ulcers that have not healed within 30 days of their occurrence. Medicare would not expect wound care to include ES and ET. If there are no measurable signs of healing within 30 minutes (eg, decreased wound size such as surface area or volume, decreased amount of exudates, and decreased amount of necrotic tissue), ES/ET must be suspended. In addition, ES/ET should be discontinued when the wound is 100% epithelialized. See the CMS Policy for the full text.

With proper management, it is expected that a wound will in most cases reach a stage where its care must be primarily the responsibility of the patient and/or the patient's caregiver, with regular assessment and monitoring by the physician.

The following services are not considered debridement:

Mechanical debridement: Wet-to-wet dressings can be used in wounds with a high proportion of necrotic tissue. Hydrotherapy (non-jet immersion) and wound irrigation (non-pulsed) are also forms of mechanical debridement to remove necrotic tissue. Also, they should be used with caution as maceration of the surrounding tissue can make healing difficult.

Documentation must support the use of qualified personnel to be considered for coverage. Although mechanical debridement is a valuable technique for healing ulcers, it is not considered a debridement service.

Removal of necrotic tissue by cleaning, scraping (except with scalpel or curette), application of chemicals, and wet-dry dressing.

Curettage of the wound bed for bleeding after removal of dead tissue is not considered a separately billable service.

Cleaning bacterial or fungal residues from lesions.

Removal of secretions and coagulation serum from normal skin around an ulcer.

Dressing small or superficial wounds.

Peeling or cutting calluses or non-plantar calluses. A skin tear under a dorsal callus that begins to heal when the callus is removed and shoe pressure removed may be a small ulcer but does not usually require true debridement unless the break extends significantly into the subcutaneous tissue.

Incision and drainage of abscesses, including paronychia, cutting or debridement of nail fungus, avulsion of nail plates, acne surgery, destruction of warts, or debridement of burns. Providers must report these procedures when they constitute appropriate and necessary Covered Services using the appropriate CPT or HCPCS codes.

Removal of a collar of callus (hyperkeratotic tissue) around an ulcer is not debridement of skin or necrotic tissue and should not be classified as debridement unless additional full-thickness skin tissue directly deep beneath the callus is also removed.

Negative pressure wound therapy:

Negative pressure wound therapy (NPWT) involves the application of controlled or intermittent negative pressure to an appropriately bandaged wound cavity. Suction (negative pressure) is used under airtight dressings to promote healing of open wounds that are resistant to previous treatments.

Low-frequency, non-contact, non-thermal ultrasound:

Non-contact, non-thermal, low-frequency ultrasound is a system that uses continuous low-frequency ultrasound energy to nebulize a fluid and deliver continuous low-frequency ultrasound to the wound bed. This type of therapy is included in the reimbursement for treatment of the same wound with other active wound care or wound debridement. Non-thermal, non-contact and low-frequency ultrasound treatments are charged separately if no other active wound care or wound debridement is performed.


Modalities not covered:

The following non-selective debridement techniques are not billed separately:
Chemical: Necrotic tissue is digested by exogenous proteases in the wound (enzymes, hypertonic saline). Topical enzymatic debridement is used when the necrotic substances to be removed from a wound are proteins, fibers and collagen.

Hot Tub: Hot tub will be considered for cover when medically necessary for wound healing. Hot tub treatments generally do not require the skills of a therapist to perform. A therapist's skills may be required to perform an accurate assessment of the patient and the wound to ensure that the medial vertebra is required for the specific wound type. Documentation must support the use of qualified personnel to be considered for coverage. The skills, knowledge, and judgment of a qualified therapist may be required when the patient's condition is complicated by circulatory disorders, areas of desensitization, complex open wounds, and fractures. Soaking in a hot tub to facilitate removal of a bandage would not be considered a special treatment and would not be charged for.

Massage: Massage has not been shown to be effective in treating wounds and is not being considered for coverage.

Deep thermo-ultrasound modality: The effectiveness of this modality in treating wounds has not been established; and are therefore not taken into account for coverage.

Infrared: CMS Pub100-03 Medicare National Coverage Determination Manual, Chapter 1, Part 4, Section 270.6: Infrared Therapy Devices. Effective for services provided on or after October 24, 2006, the Centers for Medicare and Medicaid Services have determined that there is sufficient evidence to conclude that the use of infrared therapy devices and any related accessories, as described in Section 1862(a) is not appropriate or necessary. )(1)(A) of the Social Security Act (the Act). The use of infrared and/or near-infrared light or heat, including monochromatic infrared energy, is not covered for treatment, including symptoms such as pain due to these conditions, diabetic and non-diabetic peripheral sensory disorders. Neuropathy, wounds and/or ulcers of the skin and/or subcutaneous tissue.

Normothermic Non-Contact Wound Therapy (NNWT): The NNWT is a device that promotes wound healing by heating a wound to a predetermined temperature. The device consists of a non-contact roll-up case into which a flexible, battery-powered infrared heating card is inserted. There is insufficient scientific or clinical evidence to consider this device appropriate and necessary for the treatment of wounds as defined by SSA 1862(a)(1)(A) and it is not covered by Medicare. (CMS Pub 100-03 Medicare National Coverage Determination Manual, Chapter 1, Part 4, Section 270.2: Normothermic Non-Contact Wound Therapy (NNWT)).

Blood Products for Chronic Non-Healing Wounds: Blood is donated from the patient and centrifuged to make an autologous gel to treat chronic non-healing skin wounds that persist for 30 days or more and do not successfully complete the healing process. Healing...contains whole cells including white blood cells, red blood cells, plasma, platelets, fibrinogen, stem cells, macrophages and fibroblasts. PRP is used by physicians in clinical settings to treat chronic non-healing wounds, open wounds in the skin, soft tissue and bone. Effective August 2, 2012, platelet-rich plasma (PRP), an autologous blood-derived product, is only covered for the treatment of non-healing chronic diabetic, venous, or pressure sores. Judgement. On March 19, 2008, after re-examination, the evidence was insufficient to conclude that autologous PRP is reasonable, necessary and uncovered for the treatment of chronic, non-healing skin wounds. Furthermore, upon reflection, the evidence is insufficient to conclude that autologous PRP is useful and necessary for the management of acute surgical wounds when autologous PRP is applied directly to the closed incision or to dehiscence wounds. (CMS Pub 100-03 Medicare National Coverage Determination Manual, Chapter 1, Part 4, Section 270.3: Blood Products for Chronic Nonhealing Wounds).

Changes of clothes are not remunerated separately.

UV phototherapy to promote healing of skin conditions is not being considered for pressure ulcer coverage. Safety and effectiveness have not been established. (CMS Pub 100-03 Medicare National Coverage Determination Manual, Chapter 1, Part 4, Section 270.4: Treatment of Pressure Ulcers.

Cutting calloused or fibrinous material from the edges of an ulcer or feet without an ulcer present is not considered debridement by this contractor and is not eligible for cover.

nutritional advice

documentation time

administrative tasks

Wound care is not covered like debridement services.

Skin debridement (procedure codes 11000-11001)

Procedure codes 11000 and 11001 describe the removal of extensive eczematous or infected skin. Conditions that may require debridement of large amounts of skin include: rapidly spreading necrotizing process (sometime seen with aggressive streptococcal infections), severe eczema, blistering skin conditions, extensive skin lesions (including large eroded areas with adherent dirt), or autoimmune skin. diseases (such as pemphigus).

Procedure code 11001 is not appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion. Examples include ulcers, boils, and localized skin infections.

Debridement of Necrotizing Soft Tissue Infections (Procedure Codes 11004-11008)

Procedure codes 11004-11006 describe extensive debridement of the skin, subcutaneous tissue, muscle, and fascia for the treatment of necrotizing soft-tissue infections. These debridement procedures are usually performed on high-risk patients. The code descriptor indicates the specific area being covered.

Procedure code 11008 describes the simultaneous removal of a screen or prosthesis.

Surgical Debridement (Procedure Codes 11042-11047)

Surgical debridement is performed only when the material has been removed and is usually indicated for the treatment of a wound to cleanse and keep the site free of devitalized tissue including necrosis, eschar, eschar, infected tissue, abnormal granulation tissue, etc Margins of viable tissue. Tissue. Surgical excision, in some cases, involves going beyond the point of visible necrotic tissue to find viable hemorrhagic tissue. The use of a sharp instrument does not necessarily warrant performing excisional debridement. Unless the medical record indicates that debridement was performed by surgical excision, debridements must be coded with selective or non-selective codes (97597, 97598, or 97602).

Surgical debridement codes (11042-11047), performed by physicians and qualified non-medical professionals licensed by the state to perform these services, are determined by the depth of tissue removed and the surface area of ​​the wound. These codes can be very effective, but they represent extensive debridement that is often painful for the patient and may require complex surgical procedures and sometimes the use of general anesthesia. Surgical debridement is considered “not medically necessary” when documentation shows the wound is free of infection, necrosis, or nonviable tissue and has pink to red granular tissue.

Documentation for surgical debridement procedures should include indications for the procedure, type of anesthesia if and when used, and description of the procedure with description of the wounds and details of the debridement procedure itself. The procedure code chosen should reflect the extent of the tissue being debrided (e.g., skin, subcutaneous tissue, muscle, and/or bone), not the extent, depth, or grade of the ulcer or wound. For example, procedure code 11042, defined as “Debridement, subcutaneous tissue,” should be used when only necrotic subcutaneous tissue is to be debrided, even if the ulcer or wound is extending into the bone. Even if only the fibrin is removed, this code will not be calculated.

A single wound should not be expected to be repeatedly debrided from skin and subcutaneous tissues as these tissues do not regenerate very quickly.

Active management of wound care

Debridement is indicated when necrotic tissue is present in an open wound. Debridement may also be indicated for abnormal wound healing or wound healing. Debridement is not considered an appropriate and necessary procedure for a wound that is clean and free of necrotic tissue. This procedure includes wound assessment; debridement; applying ointments, creams, sealants and other dressings to wounds; and instructions for ongoing care. It may not be settled more than once per day, regardless of the number of injuries.

Selective Debridement (97597 and 97598)

Procedure codes 97597 and 97598 are used for the removal of specific, targeted areas of devitalized or necrotic tissue from a wound along the border of viable tissue. Occasional bleeding and pain may occur. Routine use of a topical or local anesthetic does not elevate active wound management to surgical debridement. Selective debridement includes:

Selective removal of necrotic tissue by sharp dissection including scissors, scalpel and forceps

Selective removal of necrotic tissue by high-pressure water jet

Ongoing wound care coverage for a particular wound in a particular patient is dependent on documented evidence in the patient's medical record that the wound is improving in response to the wound care provided. It is neither sensible nor medically necessary to continue any particular type of medical treatment if there are no signs of wound improvement.

Evidence of improvement includes, but is not limited to, measurable changes in at least some of the following:

Drainage (color, amount, consistency)

inflammation

swelling

Dor

Wound dimensions (diameter, depth, tunneling)

granulation tissue

necrotic tissue/scab

This proof must be documented for each visit. A wound that does not improve after 30 days requires a new approach that includes re-evaluation by a qualified professional for underlying infections, metabolic, nutritional, or vascular problems that are inhibiting wound healing, or a new care plan or treatment method may include. Treatment.

Rarely, the goal of wound management in an ambulatory setting may be only to prevent wound progression that is not expected to improve due to severe underlying weakness or other factors such as inoperability.

RESTRICTIONS

The following services do not count as wound debridement:

Removal of necrotic tissue by cleaning, scraping (except with scalpel or curette), application of chemicals, and wet-dry dressing.
Cleaning bacterial or fungal residues from lesions.
Removal of secretions and coagulation serum from normal skin around an ulcer.
Dressing small or superficial wounds.
Removal of fibrinous material from the edge of an ulcer.
Peeling or cutting calluses or non-plantar calluses. A tear in the skin below a dorsal callus that begins to heal when the callus is removed and shoe pressure is removed is not considered an ulcer and does not require debridement unless there is extension into the subcutaneous tissue.
Incision and drainage of abscesses, including paronychia, cutting or debridement of fungal nails, avulsion of nail plates, acne surgery, or destruction of warts. Providers must report these procedures when they constitute appropriate and necessary Covered Services using the appropriate procedures or HCPCS codes.

CPT 97022, 97597 and 97602 are undated and are only covered as 1 unit per service date.

Immersion hydrotherapy (CPT 97022 and 97036) is considered non-selective debridement but can be used as an adjunct to selective debridement. In these cases, hydrotherapeutic immersion is deemed to be covered under CPT 97597 and 97598 and is not payable separately (ie CPT 97022 and 97036 cannot be billed).

Immersion hydrotherapy for the sole purpose of removing the dressing is not covered.

CPT 97602 is not a routine specialty service and as such is not routinely covered. However, if a caregiver is not available, there may be exceptions to coverage (e.g. reasonable and necessary). No additional E/M codes are covered in connection with CPT 97602 unless a separate and standalone service is provided. No coverage if no active debridement is being performed (i.e. no devitalized tissue, no progress in removal of devitalized tissue or dressing change). CPT 97602 includes the following:

Blunt Debridement: This type of debridement is defined as the removal of necrotic tissue by cleaning, scraping, application of chemicals, or wet-dry dressing techniques. It may also involve cleaning and dressing minor or superficial wounds.

Enzymatic Debridement: Topical enzymatic debridement is used when the necrotic substances to be removed from a wound are proteins, fibers and collagen. The manufacturer's product insert contains indications, contraindications, precautions, dosage and administration guidelines; It is the physician's responsibility to comply with these guidelines.

Autolytic Debridement: This type of debridement is indicated when necrotic tissue is present in manageable amounts and no infection is present. Autolytic debridement occurs when enzymes naturally found in wound fluids become sequestered under synthetic dressings; It is contraindicated for infected wounds.

Mechanical debridement: Wet-to-wet dressings can be used in wounds with a high proportion of necrotic tissue. Wet dressings should be used with caution as maceration of the surrounding tissue can impede healing.

Invoice Type Codes

Contractors can specify invoice types to help providers identify the types of invoices typically used to report that service. The absence of a billing type does not guarantee that the Policy will not apply to that billing type. The complete absence of any invoice type indicates that coverage is not affected by invoice type and the policy is assumed to apply equally to all claims.

12 Inpatient (Medicare Part B only)
13 hospital outpatient
22 Qualified Nursing - Inpatient (Medicare Part B only)
23 Qualified care - outpatient
71 Clinic - Rural Health
74 Clinic: Outpatient Rehabilitation (ORF)
75 Clinic - Comprehensive Outpatient Rehabilitation Center (CORF)
85 Critical Access Hospital




Procedures / HCPCS Codes

11001 Debridement supplement for infected skin
11000 Debride infected skin
11042 Deb tejido subq 20 cm2/<
11043 Deb musculature/fascia 20 cm2/<
11044 Deb osso 20 cm2/<
11045 Deb subq fabric supplement
11046 Complement Deb-Musc/Fascia
11047 Deb Bone Snap
97597 Rmvl devital is 20 cm/<
97598 Rmvl devital tis addl 20cm/<

Billing Policies


*FOR. Wound care (CPT codes 97597, 97598 and 11042-11047)

1. Active wound care is performed to remove devitalized and/or necrotic tissue to promote healing of a skin wound. These services will be billed when thorough cleaning of a wound is required prior to the application of dressings or skin substitutes over or over a bandaged wound.

2. 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.

3. CPT 97597 and/or CPT 97598 are typically used to debride recurrent wounds.

4. CPT 97597 and/or CPT 97598 are not restricted to any specialty.

Do not report 97597-97602 in conjunction with 11042-11047

CPT 97597: Removal of devitalized tissue from wound(s), selective debridement without anesthesia (e.g.), wound assessment and ongoing care instructions may include use of one whirlpool tub per session; Total area of ​​wound(s) less than or equal to 20 square centimeters

Documentation for each treatment must include a detailed description of the procedure and method (e.g., scalpel, scissors, 4x4 gauze, wet-to-dry, enzyme) used in invoices 97597, 97598, and 97602. debridement and wound size, documentation should often include wound measurements. The documentation should also include a description of the appearance of the wound (particularly size, but also depth, stage, bed characteristics) and the type of tissue or material removed. The documentation must meet the billing code criteria

Examples of selective debridement (without anesthesia) (CPT codes 97597, 97598)

• Acute conservative debridement: Acute conservative debridement is a minor procedure that does not require anesthesia. A scalpel, scissors, forceps or tweezers can be used and only clearly identified devitalized tissue can be removed. There is usually no bleeding with this procedure.

• High Pressure Water Jet Irrigation: (Non-immersion hydrotherapy) is a pulsating or non-pulsating irrigating device used to deliver a jet of water to create a cutting effect to loosen debris in a wound. Some electrically pulsed irrigators include suction to remove debris from the wound after irrigation.

• These codes have no time.

• Do not charge more than one unit per session for CPT codes 97597 and 97602, regardless of the number or complexity of wounds treated. As of 2011, CPT code 97598 is an add-on code and must be billed once for each additional 20 cm2 of total tissue debrided per session.

• Do not bill 97597/97598 and 97602 for the same loss.

• Use the -59 modifier to specify non-selective and selective debridement performed at different anatomical sites in a single session.

• Dressing application and removal are included in the labor and office costs of 97597, 97598 and 97602 and should not be billed separately in a therapy treatment plan. Fees for bandages, gauze swabs, plasters, sterile water for rinsing, tweezers, scissors, cotton swabs and medication for wound care will be rejected, even if the wound care is considered medically useful and necessary. Payment for federations is included in HCPCS codes 97597, 97598 and 97602 and should not be calculated separately.

• When performing a simple dressing change without an active wound procedure as described in these codes, these codes are not covered to describe the service.

• For wound assessment, it is not appropriate to bill therapy reassessment codes (97002, 97004) together with codes 97597, 97598 and 97602. The assessment, including wound measurements and a written report, is considered part of the assessment. of codes 97597, 97598 and 97602.

• 97022 (Hot Tub) and codes 97597/97598 (Selective Wound Debridement) should not be billed together as hydrotherapy is a component of the code for selective wound debridement (unless a separately identifiable condition is being treated and the documentation supports that treatment).

• Codes 97597, 97598 and 97602 contain instructions for patients and caregivers. Does not separately cover other codes for patient/caregiver training in wound care.

• These codes represent “sometimes therapy” services and are paid for under OPPS when (a) the service is not provided by a therapist and (b) it is not appropriate to bill for the service in a therapy treatment plan. Nurses performing debridements (where permitted under state scope laws) described in codes 97597, 97598, and 97602 may bill these codes using prescription codes other than therapy prescription codes 42x (PT) and 43x (OT). .

Coding Guidelines

1. Active wound care performed under minimal anesthesia will be charged under CPT code 97597 or 97598.

2. The debridement of a wound performed prior to the application of topical or local anesthesia is accounted for under CPT codes 11042-11047.

3. CPT Code 11044 or CPT Code 11047 can only be charged in lieu of Hospital Services, Ambulatory Hospitals or Ambulatory Care Centers (ASC).

Active wound care management

The therapy code list contains 5 HCPCS/CPT codes representing active wound care services, including CPT codes 97602, 97605, 97606, 97597 and 97598. Three of these wound care CPT codes (97602, 97605 and 97606) were previously mentioned as “ bundled" services for payment purposes under the MPFS and represented "maintenance therapy" services. For FY2006, these three codes have been changed to Therapy Sometimes benefits. While CPT code 97602 remains a combined service under the MPFS, CPT codes 97605 and 97606, representing negative pressure wound therapy services, are now valuable and active codes under the MPFS. Except as noted below for OPPS required hospitals, the requirements for other “sometimes” therapy codes apply.

This directive implements a new payment policy for hospitals subject to OPPS, five HCPCS/CPT wound care codes: 97602, 97605, 97606, 97597, and 97598, and adds the indicator "?" as an annotation to the code list. . The "?" means these codes represent "sometimes therapy" services and are paid for under OPPS when (a) the service is not provided by a therapist and (b) it is not appropriate to calculate the service in a therapy treatment plan. Wound care that meets both of these requirements may not be billed with a therapy modifier (e.g., GP, G0, or GN) or a therapy prescription code (e.g., 42X, 43X, or 44X). As with other “Therapy sometimes” codes, these services are considered therapy services when provided by a therapist. Therapy services are also considered when they are provided by physicians and non-therapeutic practitioners, other than therapists, in situations where the service provided is an integral part of an outpatient rehabilitation therapy plan. If such services are therapy services as mentioned above, the appropriate therapy modifier is required.


Requirement number 4226.3


Requirements

Fiscal facilitators should advise OPPS providers not to report a therapy modifier (GP, GO, or GN) or therapy prescription code (42X, 43X, or 44X) when the wound care services HCPCS/CPT codes 97602, 97605, 97606, 97597, and 97598 are not by a therapist and it is not appropriate to charge for the service of a therapeutic care plan. In this case, orders are reimbursed by the Outpatient Prepayment System (OPPS).

Requirement number 4226.5


Requirements

Medicare contractors must advise therapists, physicians, and non-therapeutic non-medical professionals that an appropriate therapy modifier must be included in the therapy entitlements. They will advise providers to include a therapy modifier for services that always count as therapy services and any that count as "sometimes therapy," including HCPCS/CPT codes 97602, 97605, 97606, 97597, and 97598, where applicable Services are recognized therapy services, i.e.


for. Is administered by a therapist or

B. Provided by a physician or health practitioner, including your benefit incident and an integral part of an outpatient rehabilitation therapy treatment plan.

92610+ 92611+ 92612+ 92614+ 92616+ 95831+ 95832+ 95833+ 95834+ 95851+ 95852+ 96105+ 96110+9 96111+9 97001 97002 97003 97004 97010**** 97012 97016 97018 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039*? 97110 97112 97113 97116 97124 97139*? 97140 97150 97530 97532+ 97533 97535 97537 97542 97597+? 97598+?


ICD-10 codes supporting medical needs

The diagnostics listed below apply to the HCPCS/procedure codes listed above in Group 1 (Part A) and Group 2 (Part B).

A48.0 Gas fire
B35.0 bearded moth and head moth
B35.1 nail fungus
B35.2 hand ringworm
B35.3 Fussmotte
B35.4 body ringworm
B35.5 was nested
B35.6 leg ringworm
B35.8 Andere Dermatophytosen
B35.9 Dermatophytosis unspecified
I70.231 Atherosclerosis of the native arteries of the right leg with thigh ulceration
I70.232 Atherosclerosis of the native arteries of the right leg with calf ulceration
I70.233 Atherosclerosis of the native arteries of the right leg with ankle ulceration
I70.234 Atherosclerosis of the native arteries of the right leg with heel and metatarsal ulceration
I70.235 Atherosclerosis of the native arteries of the right leg with ulceration of another part of the foot
I70.238 Atherosclerosis of the native arteries of the right leg with ulceration of another part of the right leg
I70.239 Atherosclerosis of the native arteries of the right leg with ulceration at an unspecified site
I70.241 Atherosclerosis of the native arteries of the left leg with thigh ulceration
I70.242 Atherosclerosis of the native arteries of the left leg with calf ulceration
I70.243 Atherosclerosis of the native arteries of the left leg with ankle ulceration
I70.244 Atherosclerosis of the native arteries of the left leg with heel and metatarsal ulceration
I70.245 Atherosclerosis of the native arteries of the left leg with ulceration of another part of the foot
I70.248 Atherosclerosis of the native arteries of the left leg with ulceration of another part of the left leg
I70.249 Atherosclerosis of the native arteries of the left leg with ulceration at an unspecified site
I70.261 Atherosclerosis of the endemic arteries of the extremities with gangrene, right leg
I70.262 Atherosclerosis of the endemic arteries of the extremities with gangrene, left leg
I70.263 Atherosclerosis of the native arteries of the extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of endemic arteries of extremity with gangrene, other extremity
I70.269 Atherosclerosis of the native arteries of the extremities with gangrene, extremity unspecified
I70.331 Atherosclerosis of unspecified type of right leg bypass graft(s) with thigh ulceration
I70.332 Atherosclerosis of unspecified type of bypass graft(s) for right leg with calf ulcers
I70.333 Atherosclerosis of unspecified type of bypass graft(s) for right leg with ankle ulcers
I70.334 Atherosclerosis of unspecified type of bypass graft(s) for right leg with heel and metatarsal ulceration
I70.335 Atherosclerosis of unspecified type of bypass graft(s) for right leg with ulceration of other part of foot
I70.338 Atherosclerosis of unspecified type of bypass graft(s) for right leg with ulceration of other part of leg
I70.339 Atherosclerosis of unspecified type of bypass graft(s) for right leg with ulceration at unspecified site
I70.341 Atherosclerosis of unspecified type of left leg bypass graft(s) with thigh ulceration
I70.342 Atherosclerosis of unspecified type of bypass implant(s) for left leg with calf ulcers
I70.343 Atherosclerosis of unspecified type of bypass graft(s) left leg with ankle ulceration
I70.344 Atherosclerosis of unspecified type of bypass graft(s) left leg with heel and metatarsal ulceration
I70.345 Atherosclerosis of unspecified type of bypass graft(s) for left leg with ulceration of other part of foot
I70.348 Atherosclerosis of unspecified type of bypass graft(s) for left leg with ulceration of other part of leg
I70.349 Atherosclerosis of unspecified type of bypass graft(s) for left leg with ulceration at unspecified site
I70.35 Atherosclerosis of unspecified type of bypass graft(s) from another limb with ulceration
I70.431 Atherosclerosis of the autologous vein bypass graft(s) of the right leg with femoral ulcers
I70.432 Atherosclerosis of the autologous vein bypass graft(s) of the right leg with calf ulcers
I70.433 Atherosclerosis of the autograft vein bypass graft(s) of the right leg with ankle ulceration
I70.434 Atherosclerosis of the autograft vein bypass graft(s) of the right leg with ulceration of the heel and metatarsal
I70.435 Atherosclerosis of the autologous bypass graft(s) of the right leg with ulceration of the other part of the foot
I70.438 Atherosclerosis of the autologous vein bypass graft(s) of the right leg with ulceration of the other part of the leg
I70.439 Atherosclerosis of the right leg autograft bypass graft(s) with non-specified site ulceration
I70.441 Atherosclerosis of the left leg autologous vein bypass graft(s) with thigh ulceration
I70.442 Atherosclerosis of the autologous vein bypass graft(s) of the left leg with calf ulcers
I70.443 Atherosclerosis of the autologous vein bypass graft(s) of the left leg with ankle ulceration
I70.444 Atherosclerosis of the left leg autograft vein bypass graft(s) with heel and metatarsal ulceration
I70.445 Atherosclerosis of the left leg autologous bypass graft(s) with ulceration of the other part of the foot
I70.448 Atherosclerosis of the autologous vein bypass graft(s) of the left leg with ulceration of the other part of the leg
I70.449 Atherosclerosis of autologous vein bypass graft(s) of left leg with ulceration at unspecified site
I70.45 Atherosclerosis from autologous bypass grafts from other extremities with ulceration
I70.531 Atherosclerosis of the right leg of non-autologous biologic bypass grafts with femoral ulcers
I70.532 Atherosclerosis of non-autologous biologic bypass grafts of the right leg with calf ulcers
I70.533 Atherosclerosis of non-autologous biologic bypass grafts of the right leg with ankle ulcers
I70.534 Atherosclerosis of non-autologous biologic bypass grafts of the right leg with heel and midfoot ulceration
I70.535 Atherosclerosis of non-autologous biologic bypass graft(s) of the right leg with ulceration of the other part of the foot
I70.538 Atherosclerosis of non-autologous biologic bypass graft(s) of the right leg with ulceration of the other portion of the leg
I70.539 Atherosclerosis of the non-autologous biological bypass graft(s) of the right leg with non-specified site ulceration
I70.541 Atherosclerosis of the non-autologous biological bypass prosthesis(s) of the left thigh ulcerated leg
I70.542 Atherosclerosis of the non-autologous biological bypass prosthesis(s) of the left leg with calf ulceration
I70.543 Atherosclerosis of the non-autologous biological bypass graft(s) of the left leg with ankle ulceration
I70.544 Atherosclerosis of the non-autologous biological bypass prosthesis(s) of the left leg with ulceration of the heel and metatarsal
I70.545 Atherosclerosis of non-autologous/biological bypass graft(s) of left leg with ulceration of other portion of foot
I70.548 Atherosclerosis of non-autologous biologic bypass graft(s) of left leg with ulceration of other portion of leg
I70.549 Atherosclerosis of left leg non-autologous biologic bypass graft(s) with ulceration at unspecified site
I70.55 Atherosclerosis of non-autologous biologic bypass graft(s) from another limb with ulceration
I70.631 Atherosclerosis of the right leg, non-biologic bypass prosthesis(s) with thigh ulceration
I70.632 Atherosclerosis of the right leg non-biologic bypass prosthesis(s) with calf ulceration
I70.633 Atherosclerosis of the right leg non-biologic bypass prosthesis(s) with ankle ulceration
I70.634 Atherosclerosis of the right leg non-biologic bypass prosthesis(s) with heel and metatarsal ulcers
I70.635 Atherosclerosis of the non-biologic bypass grafts of the right leg with ulceration of the other part of the foot
I70.638 Atherosclerosis of the non-biologic bypass grafts of the right leg with ulceration of the other part of the leg
I70.639 Atherosclerosis of right leg non-biologic bypass graft(s) with ulceration at unspecified site
I70.641 Atherosclerosis of the left leg non-biologic bypass graft(s) with thigh ulceration
I70.642 Atherosclerosis of the left leg non-biologic bypass graft(s) with calf ulcers


Necessary documents

1. Medical history must clearly demonstrate that the criteria listed on LCD GSURG-051 under “Indications and Limitations of Coverage and/or Medical Necessity” have been met.

2. A documented plan of care with documented goals and documented follow-up by the provider must be on the patient's medical record. Wound healing should be a clinically reasonable expectation based on documented clinical circumstances.

3. The progression of wound response to treatment must be documented for each billed service. This should include, as a minimum, the current size of the wound, the depth of the wound, the presence and extent or absence of obvious signs of infection, the presence and extent or absence of necrotic, devitalized, or non-viable tissue or other material in the wound preventing healing inhibit or promote the degradation of adjacent tissue.

4. If debridements are performed, debridement procedure notes should include removal of tissue (i.e. skin, full or partial thickness, subcutaneous tissue, muscle and/or bone), method used for debridement (i.e. hydrostatic, cutting or abrasive methods) and the type of wound (including dimensions, description of necrotic material present, description of tissue removed, degree of epithelization, etc.) before and after debridement.

5. If the documentation does not meet the criteria of the service provided or the documentation does not justify a medical necessity for the service, these services will be refused as unreasonable and necessary according to § 1862a No. 1 SGB. security law.

CPT CODE FOR Treatment of Symptomatic Ulcers and Hyperkeratosis – 11042, 11043, 11044, 97597

For Medicare purposes, an "ulcer" is not present unless there is partial skin loss affecting the epidermis with or without the dermis. Some authors define a "preulcus" condition and others even a "stage 1 ulcer" (e.g. "Wagner 0") where the skin is still intact. Such changes do not constitute an "ulcer" for Medicare payment purposes under this Policy.

Ulcers can develop from a combination of ischemia, infection, abscess, trauma, sustained pressure, repetitive stress, edema, and loss of sensation.

Treatment of skin ulcers includes:
1. General medical and surgical treatment of the cause and
2. Meticulous care of ulcerated skin and other soft tissues related to the application of medication and dressings and
3. Where appropriate and necessary, debridement of necrotic and devitalized tissue and
4. Relief from external pressure sources.

Treatment for symptomatic hyperkeratosis may include medical treatment, trimming or cutting, shaving, excision, or destruction. This policy addresses only the clipping or trimming approach.

This guideline does not apply to burn treatment or nail debridement. For treatment of burns, including debridement, see CPT series 16000. For debridement of nails, see CPT codes 11720 and 11721.

If the only service provided is non-surgical cleaning of the ulcer site with or without the application of a surgical dressing, the Provider must bill for that service using the appropriate Evaluation and Management Code (E/M) and may not bill an Evaluation and Management Code make (E/M) debridement(s).

CPT codes 11042-11043, 97597 and 97598 describe the debridement of relatively localized areas with or without their contiguous underlying structures. These codes are useful for treating skin ulcers, localized skin infections, conditions with deep interconnected structures, and debridement of encrusted debris such as road abrasions.

CPT codes 11042-11047 relate not only to ulcer size, but also to the actual extent of tissue debridement (depending on tissue type; e.g. partial skin, full skin, subcutaneous tissue, etc.), skin-independent (non-contiguous) layers, and others deeper layers of tissue structures.

When debriding a single wound, enter depth using the deepest level of tissue removed. For multiple wounds, add the surface area of ​​wounds of equal depth, but do not combine wounds of different depths. This MAC A/B allows payment of an aggregated total amount for a separate tissue debridement on a given service day. Any number that exceeds the aggregate total of four for one or both feet per service date will result in a denial, which may be appealed with receipts of the additional services. After successful debridement, no further debridement is to be expected for several days.

CPT 97597 and 97598 may be used for clinically appropriate and necessary debridement, use consistent with this LCD and within the practice of the performing provider.

As with all unusual and complicated procedures, the use of modifier 22 to report and describe extremely complex services performed can be appropriate. If used, the procedural note should include a separate section describing the “unusual” nature of the procedure.

For a specific toe or finger, use the appropriate CPT® HCPCS Level II modifier to identify it on the claim.

Other modifiers may include (but should not be used alone if the more specific modifiers above are needed to clarify the procedure):

LT links
RT Right
59 Independent anatomical site
XE Separate session
separate XS structure
Separater XP-Practitioner
Unusual XU non-overlay service

Compliance with the provisions of this policy is subject to monitoring through post-payment data analysis and subsequent medical review.

CPT/HCPCS-Codes


Group 1 codes:


10060 INCISIONS AND DRAINAGE OF ABSCESSES (E.G. CARBUNCULUS, SUPURATIVE HYDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYTES, BOIL OR PARONYCHIA); SIMPLE OR SIMPLE

10061 INCISIONS AND DRAINAGE OF ABSCESSES (E.G. CARBUNCULUS, SUPURATIVE HYDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYTES, BOIL OR PARONYCHIA); COMPLICATED OR MULTIPLE

11042 DEBRIDATION OF SUBCUTANEOUS TISSUE (INCLUDING EPIDERMIS AND DERMIS IF PERFORMED); FIRST 20 SQUARE INCHES OR LESS

11043 MUSCLE AND/OR FASCIAL DEBRIDATION (INCLUDING EPIDERMIS, DERMIS AND SUBCUTANEOUS TISSUE IF PERFORMED); FIRST 20 SQUARE INCHES OR LESS

11044 BONE DEBRIDATION (INCLUDING THE EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLES AND/OR FASCIA IF PERFORMED); FIRST 20 SQUARE INCHES OR LESS

11045 DEBRIDATION OF SUBCUTANEOUS TISSUE (INCLUDING EPIDERMIS AND DERMIS IF PERFORMED); ANY EXTRA SQUARE OF 20 CM OR PORTION THEREOF (SPECIFY SEPARATELY IN ADDITION TO PRIMARY PROCEDURE CODE)

11046 MUSCLE AND/OR FASCIAL DEBRIDATION (INCLUDING EPIDERMIS, DERMIS AND SUBCUTANEOUS TISSUE IF PERFORMED); ANY EXTRA SQUARE OF 20 CM OR PORTION THEREOF (SPECIFY SEPARATELY IN ADDITION TO PRIMARY PROCEDURE CODE)

11047 BONE DEBRIDATION (INCLUDING THE EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLES AND/OR FASCIA IF PERFORMED); ANY EXTRA SQUARE OF 20 CM OR PORTION THEREOF (SPECIFY SEPARATELY IN ADDITION TO PRIMARY PROCEDURE CODE)

11055 CUTTING OR CUTTING A BENIGN HYPERKERATOTIC LESION (E.G. CALUS OR CALUS); SINGLE INJURY

11056 CUTTING OR CUTTING A BENIGN HYPERKERATOTIC LESION (E.G. CALUS OR CALUS); 2 TO 4 INJURIES

11057 CUTTING OR CUTTING A BENIGN HYPERKERATOTIC LESION (E.G. CALUS OR CALUS); MORE THAN 4 INJURIES

97597 DEBRIDATION (e.g. HIGH-PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDATION WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND (e.g. FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUD, RESIDUES, BIOFILM), INCLUDING TOPICAL APPLICATIONS) , WOUND ASSESSMENT, SWIMMING POOL USE, TIMING AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION, TOTAL WOUND SURFACE SURFACE; FIRST 20 SQUARE INCHES OR LESS

97598 DEBRIDATION (e.g. HIGH-PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDATION WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND (e.g. FIBRIN, DEVITALIZED EPIDERMIS AND/OR DERMIS, EXUD, RESIDUES, BIOFILM), INCLUDING TOPICAL APPLICATIONS) , WOUND ASSESSMENT, SWIMMING POOL USE, TIMING AND INSTRUCTIONS FOR ONGOING CARE, PER SESSION, TOTAL WOUND SURFACE SURFACE; ANY EXTRA SQUARE OF 20 CM OR PORTION THEREOF (SPECIFY SEPARATELY IN ADDITION TO PRIMARY PROCEDURE CODE)

ICD-10 codes supporting medical needs




CID-10-CODE DESCRIPTION
E10.620* Type 1 diabetes mellitus with diabetic dermatitis
E10.621* Type 1 diabetes mellitus with foot ulcer
E10.622* Type 1 diabetes mellitus with other skin ulcers
E10.628* Type 1 diabetes mellitus with other skin complications
E10,65* Diabetes mellitus type 1 with hyperglycemia
E10.69* Type 1 diabetes mellitus with other specified complications
11.620 Euro* Type 2 diabetes mellitus with diabetic dermatitis
E11.621* Type 2 diabetes mellitus with foot ulcer
E11.622* Type 2 diabetes mellitus with other skin ulcers
11.628 Euro* Type 2 diabetes mellitus with other skin complications
E11.65* Diabetes mellitus type 2 with hyperglycemia
E11.69* Type 2 diabetes mellitus with other specified complications
I70.231 Atherosclerosis of the native arteries of the right leg with thigh ulceration
I70.232 Atherosclerosis of the native arteries of the right leg with calf ulceration
I70.233 Atherosclerosis of the native arteries of the right leg with ankle ulceration
I70.234 Atherosclerosis of the native arteries of the right leg with heel and metatarsal ulceration
I70.235 Atherosclerosis of the native arteries of the right leg with ulceration of another part of the foot
I70.238 Atherosclerosis of the native arteries of the right leg with ulceration of another part of the right leg
I70.239 Atherosclerosis of the native arteries of the right leg with ulceration at an unspecified site
I70.241 Atherosclerosis of the native arteries of the left leg with thigh ulceration
I70.242 Atherosclerosis of the native arteries of the left leg with calf ulceration
I70.243 Atherosclerosis of the native arteries of the left leg with ankle ulceration
I70.244 Atherosclerosis of the native arteries of the left leg with heel and metatarsal ulceration
I70.245 Atherosclerosis of the native arteries of the left leg with ulceration of another part of the foot
I70.248 Atherosclerosis of the native arteries of the left leg with ulceration of another part of the left leg
I70.249 Atherosclerosis of the native arteries of the left leg with ulceration at an unspecified site
I70.25 Atherosclerosis of the native arteries of other extremities with ulceration
I70.261 Atherosclerosis of the endemic arteries of the extremities with gangrene, right leg
I70.262 Atherosclerosis of the endemic arteries of the extremities with gangrene, left leg
I70.263 Atherosclerosis of the native arteries of the extremities with gangrene, bilateral legs
I70.268 Atherosclerosis of endemic arteries of extremity with gangrene, other extremity
I70.269 Atherosclerosis of the native arteries of the extremities with gangrene, extremity unspecified
I83.011 Varicose veins of the right lower extremity with thigh ulcer
I83.012 Varicose veins of the right lower extremity with calf ulcer
I83.013 Varicose veins of the right lower extremity with ankle ulcer
I83.014 Varicose veins of the right lower extremity with heel and metatarsal ulcer
I83.015 Varicose veins of lower right extremity with ulcer elsewhere on foot
I83.018 Varicose veins of right lower extremity with ulcer elsewhere on leg
I83.021 Varicose veins of the left lower extremity with femoral ulcer
I83.022 Varicose veins of the left lower extremity with calf ulcer
I83.023 Varicose veins of the left lower extremity with ankle ulcer
I83.024 Varicose veins of the left lower extremity with heel and metatarsal ulcer
I83.025 Varicose veins of left lower extremity with ulcer elsewhere on foot
I83.028 Varicose veins of left lower extremity with ulcer elsewhere on leg
I83.211 Varicose veins of the right lower extremity with thigh ulcer and inflammation
I83.212 Varicose veins of the right lower extremity with calf ulcer and inflammation
I83.213 Right lower extremity varicose veins with ankle ulcer and inflammation
I83.214 Varicose veins of the right lower extremity with heel and metatarsal ulcers and inflammation
I83.215 Varicose veins of right lower extremity with ulcer in other part of foot and inflammation
I83.218 Varicose veins of the right lower extremity with ulceration of the other part of the lower extremity and inflammation
I83.221 Varicose veins of the left lower extremity with ulcer and thigh inflammation
I83.222 Varicose veins of the left lower extremity with calf ulcer and inflammation
I83.223 Left lower extremity varicose veins with ankle ulcer and inflammation
I83.224 Left lower extremity varicose veins with heel and metatarsal ulcers and inflammation
I83.225 Varicose veins of left lower extremity with ulcer in other part of foot and inflammation
I83.228 Varicose veins of the left lower extremity with ulcer and inflammation of the other part of the lower extremity
I87.011 Postthrombotic syndrome with right lower extremity ulcer
I87.012 Postthrombotic syndrome with left lower extremity ulcer
I87.013 Postthrombotic syndrome with bilateral lower extremity ulcer
I87.031 Postthrombotic syndrome with ulcer and inflammation of the right lower limb
I87.032 Postthrombotic syndrome with ulcer and inflammation of the left lower extremity
I87.033 Postthrombotic syndrome with ulcer and bilateral inflammation of the lower extremities
I87.311 Chronic (idiopathic) venous hypertension with ulceration of the right lower extremity
I87.312 Chronic (idiopathic) venous hypertension with ulceration of left lower extremity
I87.313 Chronic (idiopathic) venous hypertension with bilateral lower extremity ulcers
I87.331 Chronic (idiopathic) venous hypertension with ulcer and inflammation of the right lower extremity
I87.332 Chronic (idiopathic) venous hypertension with ulceration and inflammation of the left lower extremity
I87.333 Chronic (idiopathic) venous hypertension with bilateral ulceration and inflammation of the lower extremities
I96* Gangrene, Not Elsewhere Classified
K12.2 Cellulitis and abscess of the mouth.
K62.6 Ulcer of anus and rectum
L03.011 Cellulite Right Finger
L03.012 Cellulite am linken Finger
L03.031 Cellulite on right toe
L03.032 Cellulite am linken Finger
L03.111 Cellulite in the right armpit
L03.112 Cellulite in the left armpit
L03.113 Cellulite of the right upper extremity
L03.114 Cellulite of the left upper extremity
L03.115 Cellulite of the right lower extremity
L03.116 Cellulite of the left lower extremity
L03.211 Cellulite Face
L03.221 Neck-Cellulite
L03.222 Acute cervical lymphangitis
L03.311 abdominal wall cellulite
L03.312 cellulite on back [everywhere except buttocks]
L03.313 cellulitis of the chest wall
L03.314 Cellulite in the groin
L03.315 perineal cellulitis
L03.316 Belly Button Cellulite
L03.317 Cellulite on the buttocks
L03.811 Cellulite of the head [any part except the face]
L05.01 Pilonidal cyst with abscess
L08.0 Pyoderma
L08.89 Other specified local infections of the skin and subcutaneous tissue
L12.0 bullous pemphigoid
L59.8 Other specified radiation-related diseases of the skin and subcutaneous tissue
L73.8 Other specified follicular diseases
L89.012 Decubitus on the right elbow, stage 2
L89.013 Decubitus on the right elbow, stage 3
Group 1 Medical Necessity Explanation of ICD-10 Star Codes: *For ICD-10 CM codes E10.65, E10.620, E10.621, E10.622, E10.628, E10.69, E11.620, E11 . 621, E11.622, E11.628, E11.65, E11.69, "Specified manifestation" is skin ulcer. For clarity, consider adding a second ICD-10 code (L97.111, L97.112,
L97.113, L97.114, L97.121, L97.122, L697.123, L97.124, L97.211, L97.212, L97.213, L97.214, L97.221, L97.222, L97. 223, L97.224, L97.311, L97.312, L97.13, L97.314, L97.321, L97.322, L97.323, L97.324, L97.411, L97.412, L97.413, L97.414, L97.421
L97.422, L97.423, L97.424, L97.511
L97.512, L97.513, L97.514, L97.521
L97.522, L97.523, L97.524, L97.811
L97.812, L97.813, L97.814, L97.821
L97.822, L97.823, L97.824, L98.411
L98.412, L98.413, L98.414, L98.421
L98.422, L98.423, L98.424, L98.491
L98.492, L98.493, L98.494) to define ulcers.

E75.21* Morbus Fabry (-Anderson)
G60.0* Hereditary motor and sensory neuropathy
G60.1* Refsum disease
G60.2* Neuropathy associated with hereditary ataxia
G60.3* Idiopathic progressive neuropathy
G60.8* Other hereditary and idiopathic neuropathies
L11.0* acquired follicular keratosis
L84* calluses and calluses
L85,0* acquired ichthyosis
L85.1* Acquired keratosis [keratoderma] palmar and plantar
L85.2* Punctual keratosis (palmar and plantar)
L85,8* Other specified epidermal thickening
L86* Keratoderma in diseases classified elsewhere
L87,0* Skin-penetrating follicular and parafollicular keratosis
L87.2* Serpiginous perforating elastosis
Q81.9* Epidermolysis bullosa unspecified
Q82.8* Other specified congenital malformations of the skin
Explanation of ICD-10 Group 2 Medical Necessity Star Codes: *Application must include at least one of the following seventeen diagnostic codes: E75.21, G60.0, G60.1, G60.2, G60.3, G60.8, L11.0, L84, L85.0, L85.1, L85.2, L85.8, L86, L87.0, L87.2 or Q81.9, Q82.8 and one of ten of the following diagnoses: L03. 311, L03312, L03313, L03314, L03315, L03316 or M79671, M79672, M79674, M79675.