Q&A: Billing for wound debridement and skin substitute application

Wednesday, November 28, 2018

Q: The physician documented debridement (11043x1 & 11046x4) of a wound 85.25 sq. cm and documented 20 sq. cm of skin substitute application (15271). My coder says that 11043/11046 is included in 15271 and we can't separately bill for them with 15271. Do we bill 15271 as the size of the debridement documented or only the size of the skin substitute?

A: It depends on the documentation. The Current Procedural Terminology guidelines state that debridement is considered a separate procedure "when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure." If the documentation supports that 20 sq. cm of the total 85.25 sq. cm involved a skin substitute application, you can report 15271 for the 20 sq. cm and then debridement codes (with an appropriate modifier) for the remaining 65 sq. cm. Be sure that the documentation supports that the wound area covered by the skin substitute was 20 sq. cm and not just that the size of the skin substitute was 20 sq. cm; we know that many times the actual size of the skin substitute is larger than the area that was covered. The physician documentation is the key to being able to support both codes. If there is not enough clarity, then a query would be indicated.

Note: This question can be found in the billing and claims category on the NAHRI Forums where you can find answers to questions on a variety of topics from billing and claims to compliance to reimbursement. This question was answered by Denise Williams, COC, senior vice president of the revenue integrity division and compliance auditor at Revant Solutions in Trussville, Alabama.