11040 and Wound Closure: Watch Out for These Conditions to Explain Separate Reporting

Concentrate on the level of wound repair to maximize your reimbursement.

A lot of clinical scenarios do not need dermatologists to carry out debridement as a distinct service from wound closure. Though, recognizing the times when it is essential can help your practice get the full reimbursement it is worthy of. Follow the expert medical billing and coding advice given below and know what CPT codes apply.

In case you're considering reporting debridement distinctly from a wound closure, ensure that your dermatologist's notes clearly document that the wound was contaminated and needed instrumentation and saline or other substances to cleanse and debride the wound. You would require doing a sharp removal to use the debridement code.

Don't miss: In case you report a debridement code, for instance 11040 (Debridement; skin, partial thickness), along with your wound closure CPT codes, append modifier 59 (Distinct procedural service) to the debridement code. This tells the payer that you recognize that debridement is mostly bundled into wound repair, however that clinical circumstances needed the dermatologist to carry out debridement as a separate service.

1. Watch Out for Wound Repair With the Debridement

CPT® specifies that you might also report debridement CPT codes independently of repair CPT codes once the dermatologist gets rid of large amounts of devitalized or contaminated tissue or once the dermatologist carries out debridement without immediate primary repair of a wound.

The dermatologist might clean debris from the wound excluding repairing the wound as it was not deep enough to need repair or the dermatologist delayed the repair because of an extenuating circumstance.

For instance: The dermatologist may not have sufficient time to repair the wound at that particular time, or the patient may present with a more important skin condition that needs medical attention first. In such an instance, you can bill debridement for full, distinct payment minus a wound repair code.

Even though dermatologists most commonly clean a wound instantly before they repair it, you wouldn't report a debridement code separately. Don't miss: The debridement procedure may also require a repair procedure that will affect your medical billing report.

2. Don't Oversee Intermediate Wound Closure for Your Extensive Debridements

In case the dermatologist carries out a simple repair with nominal amounts of debridement, for example, you must only report a simple repair code (12001-12021). In case that same wound requires extensive cleaning or removal of particulate matter, you may, as an alternative, report an intermediate repair code (12031-12057).

Money opportunity: There is an important difference in payment between simple plus intermediate repair CPT codes. Reporting code 12001 (Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities [including hands and feet]; 2.5 cm or less) will reimburse you about $93.60, whereas 12031 (Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities [excluding hands and feet]; 2.5 cm or less) may pay $235.20.

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