The documentation in the medical record should reflect what type of debridement was performed and be clear as to why it was done.

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DEBRIDEMENT - Proper
Documentation Crucial
for Accurate Coding
918-221-7769
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Debridement is a key element in hospital and ambulatory surgical
center (ASC) medical billing. Physicians remove unhealthy tissue from
a wound using excisional and non-excisional techniques. However, lack
of proper documentation often leads to miscoding of surgical wound
debridement and this has made debridement claims a target of
recovery audit contractors (RACs) and also by the Office of Inspector
General (OIG) and the Centers for Medicare & Medicaid Services
(CMS). Medical coding outsourcing companies can ensure error-
free claim submission only if the physician meets the stringent
documentation requirements for reporting surgical debridement.
Debridement involves the removal of necrotic or dead tissue to
establish a viable margin, reduce risks of infection and promote wound
healing. In addition to necrotic tissue, tissue necessary to establish a
viable margin includes senescent cells, rolled skin edges, undermined
edges, and abnormal granulation tissue. The different types of
debridements are:
- Excisional
- Selective, and
- Non-selective
Each category has its own set of CPT codes.
There are different methods of wound debridement -- surgical,
mechanical, autolytic, biologic, enzymatic, and other approaches.
ICD-10 defines excision as cutting out or off, without replacement, a
Different Types of Debridement

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portion of a body part and excision debridement is considered as a
surgical procedure. Surgical excision includes going slightly beyond
the point of visible necrotic tissue until viable bleeding tissue is
encountered in some cases. The use of a sharp instrument does not
necessarily validate the performance of surgical excisional
debridement.
For the procedure to be coded as excisional debridement, the health
care provider needs to specifically document “excisional debridement”.
A 2011 American Academy of Professional Coders (AAPC) report
stresses the importance of using the “right words” to document
excisional debridement. According to the report, the five elements of
complete documentation for excisional debridement are:
- A description of the procedure as “excisional”
- A description of the instrument used to cut or excise the tissue
(e.g., scissors, scalpel, curette)
- A description of the tissue removed (e.g., necrotic, devitalized or
non-viable)
- The appearance and size of the wound (e.g., down to fresh
bleeding tissue, 7 cm x 10 cm, etc.)
- The depth of the debridement (e.g., to skin, fascia, subcutaneous
tissue, muscle, or bone)
CPT also provides the following guidelines to support an accurate code
assignment:
- For a single wound, report the depth based on the deepest level
of tissue removed.

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- For multiple wounds, sum the surface areas that are at the same
depth (do not combine sums from different depths).
 CPT codes 11000-11012: These codes describe removal of
extensive eczematous or infected skin.
11000 Debridement of extensive eczematous or infected skin; up to
10% of body surface
11001 each additional 10% of the body surface, or part thereof (to be
listed separately in addition to primary procedure)
 11001 is used in conjunction with 11000
11004 Debridement of skin, subcutaneous tissue, muscle and fascia
for necrotizing soft tissue infection; external genitalia and perineum
11005 abdominal wall, with or without fascial closure
11006 external genitalia, perineum and abdominal wall, with or
without fascial closure
11008 Removal of prosthetic material or mesh, abdominal wall for
infection (eg, for chronic or recurrent mesh infection or necrotizing soft
tissue infection) (List separately in addition to primary procedure)
 11008 is used in conjunction with 10180, 11004-11006
 11008 should not be reported in conjunction with 11000-11001,
11010-11044
 Skin grafts or flaps should be reported separately when
performed for closure at the same session as 11004-11008
Excision Debridement on the Skin - CPT Codes

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11010 Debridement including removal of foreign material at the site of
an open fracture and/or an open dislocation (eg, excisional
debridement); skin and subcutaneous tissues
11011 skin, subcutaneous tissue, muscle fascia, and muscle
11012 skin, subcutaneous tissue, muscle fascia, muscle, and bone
 Surgical Debridement (CPT codes 11042-11047)
Surgical debridement is reported only if material has been excised,
and is typically used for wound treatment to clear the site of
devitalized tissue including necrosis, eschar, slough, infected tissue,
abnormal granulation tissue etc., to the margins of viable tissue. These
codes are appropriate for treatment of skin ulcers, circumscribed
dermal infections, conditions affecting contiguous deeper structures,
and debridement of deep-seated debris from any number of injury
types. Surgical debridement codes as performed by physicians and
qualified non-physician practitioners licensed by the state to perform
those services are reported by depth of tissue removed and by surface
area of the wound.
11042 Debridement, subcutaneous tissue (includes epidermis and
dermis, if performed); first 20 sq cm or less
11043 Debridement, muscle and/or fascia (includes epidermis, dermis,
and subcutaneous tissue, if performed); first 20 sq cm or less
11044 Debridement, bone (includes epidermis, dermis, subcutaneous
tissue, muscle, and/or fascia, if performed); first 20 sq cm or less

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11045 Debridement, subcutaneous tissue (includes epidermis and
dermis, if performed); each additional 20 sq cm, or part thereof (List
separately in addition to primary procedure)
 11045 is used in conjunction with 11042
11046 Debridement, muscle and/or fascia (includes epidermis,
dermis, and subcutaneous tissue, if performed); each additional
20 sq cm, or part thereof (List separately in addition to primary
procedure
 11046 is used in conjunction with 11043
11047 Debridement, bone (includes epidermis, dermis,
subcutaneous tissue, muscle, and/or fascia, if performed); each
additional 20 sq cm, or part thereof (List separately in addition to
primary procedure)
 11047 is used in conjunction with 11044
Paring or Cutting
11055 Paring or cutting of benign hyperkeratotic lesion (eg, corn or
callus); single lesion
11056 two to four lesions
11057 more than four lesions
Unless the medical record indicates that surgical excisional
debridement has been performed, debridements should be coded with
either selective or non-selective codes
Selective and Non-selective Debridement

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 Selective debridement (CPT 97597 and 97598)
Active wound care, performed with minimal anesthesia is billed with
either CPT code 97597 or 97598 (e.g. high pressure waterjet
with/without suction, sharp selective debridement with scissors,
scalpel and forceps), open wound, (e.g.. fibrin, devitalized epidermis
and/or dermis, exudate, debris, biofilm), including topical
application(s), wound assessment, use of a whirlpool, when performed
and instruction(s) for ongoing care, per session, total wound(s) surface
area).
- 97597 is used to bill for debridement of the first 20 cm² of
aggregate wound size and CPT 97598 for any subsequent 20 cm²
increments of debrided tissue.
- 97597 and/or 97598 are billed for recurrent wound debridements
when medically reasonable and necessary.
- These codes are not limited to any specialty as long as
debridement is performed by a health care professional acting
within the scope of his/her legal authority.
- 97597 and 97598 require the presence of devitalized tissue
(necrotic cellular material). The mere removal of secretions
(cleansing of a wound) does not represent a debridement
service.
- In physical therapy medical billing of hydrotherapy
(whirlpool) with CPT codes 97597 or97598, the clinical
documentation must reflect hydrotherapy as a medically
necessary component of the total wound care treatment for
removing of devitalized and/or necrotic tissue and that the

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physical therapist’s skills were required to perform this service in
the given situation.
 Non-Selective Debridement (97022, 97036, 97602)
97022 Whirlpool; Application of a modality to one or more areas;
whirlpool, supervised
97036 Whirlpool; Application of a modality to one or more areas;
Hubbard tank, constant attendance 97036
97602 Debridement, non-selective; Removal of devitalized tissue from
wound(s); nonselective debridement without anesthesia (e.g. wet-to-
moist dressing, enzymatic, abrasion), including topical application(s),
wound assessment, and instruction(s) for ongoing care, per session.
(Note: 97602 remains available for optional use by non Medicare
payers only).
Procedural coding errors can lead to lost revenue or unintentional
upcoding at ambulatory surgery centers, according to the Texas
Medical Association. When it comes to debridement, the
documentation in the medical record should reflect what type of
debridement was performed and be clear as to why it was done. With
precise documentation, medical coding service providers can ensure
accurate code assignment, promoting clean claims and reduced risk of
audits. Expert codes would also be knowledgeable about the unique
characteristics of each debridement code as well payer guidelines for
reporting them on claims.