September 21, 2017
I debrided and ulcer. How do I know if I use 97965 or 11042?
Code 97597 is described by CPT as a debridement (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; first 20 sq cm or less. By definition it is exclusively for selective debridement of the skin, epidermis and dermis.
In contrast, code 11042, is for a deeper selective debridement, one that includes the dermis, epidermis and subcutaneous tissue. The code description states Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less.
For any debridement make sure to document the depth of the tissue debrided, the location of the debridement and the size of the debridement. Other selective debridement codes (11043 and 11044) are also coded by the depth of tissue removed; muscle and/or fascia for 11043 and bone for 11044.
*This response is based on the best information available as of 09/21/17.