Basics of Open Fracture Debridement
Debridement is used to remove foreign material or damaged, dead, or contaminated tissue from a surgical field, wound, or injury. Debridement is used to promote healthy healing of damaged skin, tissue, muscle, or bone. The debridement of small amounts of devitalized or granulation tissue during a surgical procedure is typically not billed separately.
While coding note that, debridement is separately billable when it makes up a significant portion of the procedure. As per the CPT manual, debridement may be reported separately when one of the following occurs: prolonged cleansing, appreciable amounts of devitalized tissue are removed, and/or debridement is carried out without immediate primary closure.
Open fractures are those in which the bone and/or joint is exposed to the external environment or a fracture or dislocation caused by a blunt or penetrating force sufficient to disrupt or penetrate skin layers, subcutaneous tissue, muscle fascia/muscle, and bones or joints.
Often the wound site is contaminated with foreign material (e.g., grass, twigs, dirt, oil, grass, gravel, etc) and bacteria. It may also involve the surrounding neurovascular structures, ligaments, and/or tendons, or involve dead or devitalized tissue, hemorrhaging, or swelling.
Coding for Open Fracture Debridement
Debridement of an open fracture and/or dislocation is not accurately described with the 11042–11047 CPT codes. As mentioned earlier, open fractures have considerable contamination with foreign bodies and devitalized tissue.
CPT codes 11010, 11011, and 11012 were revised to describe debridement at the site of an open fracture including removal of foreign material.
For the debridement of an open fracture includes only skin and subcutaneous tissue, use code 11010; debridement down to the muscle fascia and muscle, code 11011; and debridement that includes skin, muscle fascia, muscle, and bone, code 11012. Codes 11010–11012 can be used for debridement’s performed at the same time as the fracture reduction and fixation or for initial debridement and reduction at a later date.
- CPT 11010 Code: Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin and subcutaneous tissues
- CPT 11011 Code: Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle
- CPT 11012 Code: Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone
Above mentioned codes only report debridement of open fractures and dislocations. They should not be used to report minor debridement or the normal care that would be taken with an open fracture, such as minor excision of the wound edges (skin margin) necessary to close the defect.
Open fracture debridement codes are used when foreign material (e.g., particulate matter, dirt, or gravel) is embedded into the tissue and around or at the fracture site and requires meticulous debridement.
Key Points for Open Fracture Debridement Codes
- It is important to note that two of these codes (11011–11012) are used to report sites that usually are listed in the Musculoskeletal System 20005-29999 series of codes.
- Codes 11010-11012 represent more extensive services than those represented by 11040-11044.
- Use these codes to report debridement of the skin and other sites when an open fracture or dislocation is present. If an open fracture or dislocation is not present, use a code from the 11042–11047 series.
- Open fractures often require some debridement of the skin, subcutaneous tissue, muscle, and/or bone. Use these codes only when significant debridement of tissue is necessary.
- When an open fracture or dislocation debridement code is reported, the diagnosis must correspond to an open fracture.
- When assigning debridement codes, it is important to remember that the physician’s documentation must support the code function.
Example for Open Fracture Debridement
The patient was in an automobile accident and sustained an open fracture of the left femur. On the day of the accident, the patient was brought to the OR, and the open fracture was debrided of all necrotic tissue and debris. Under fluoroscopic guidance, the surgeon was able to manipulate the bone to create an ample reduction.
An external fixator device was used, and a dressing was applied to the open area. The open fracture of the femur is 27269, and the debridement would be 11010, along with a -59 modifier to bypass any edit.
Two days later, the patient was returned to the OR and the dressing was removed. The surgeon examined the open fracture and irrigated the wound with saline. An area of 3 cm x 4 cm was dark. The subcutaneous tissue and skin were excised with a No. 15 blade to bleeding tissue.
Some nonviable muscle tissue was also debrided. The area was then copiously irrigated, and a dressing was placed. The coding for the second debridement is 11011-58.
When multiple injuries occur, it may be necessary for the physician to perform multiple procedures to restore lost functioning. In such cases, you should accurately report all of the work involved. For that, you will require modifiers (-51, -58, -78).
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FAQs:
1. What is open fracture debridement?
Open fracture debridement is a surgical procedure that involves removing contaminated or damaged tissue and foreign material from an open fracture site to promote healing and prevent infection.
2. When can debridement be billed separately in the context of open fractures?
Debridement can be billed separately when it constitutes a significant portion of the procedure, such as when prolonged cleansing or appreciable amounts of devitalized tissue are removed.
3. What CPT codes are used for open fracture debridement?
The appropriate CPT codes are 11010 for skin and subcutaneous tissue, 11011 for skin, subcutaneous tissue, and muscle fascia, and 11012 for skin, muscle fascia, muscle, and bone.
4. What documentation is required for billing open fracture debridement?
The physician’s documentation must clearly support the necessity and extent of the debridement performed, including details about the type of tissue involved and any foreign material removed.
5. How do modifiers affect coding for open fracture debridement?
Modifiers like -59, -51, -58, and -78 are used to indicate special circumstances for multiple procedures or to bypass edits, ensuring that all services are accurately billed for the work performed.
