To help you capitalize on this year's increased reimbursements for outpatient wound care procedures, we've compiled the latest wound debridement coding and documentation requirements.

Epidermis and dermis debridement
Active wound care procedure codes are 97597 to 97602. They cover a wide range of activities: assessing the wound; debriding necrotic tissue (selective or nonselective) without the use of anesthesia; cleansing the wound; dressing the wound (including application of topical ointments, wound bed protection and bulk dressing); any patient/family instruction; and applying ointments, creams, sealants and other types of prescription wound coverings directly into the wound bed. 97597 to 97602 also cover what goes on before you debride: examining the wound to assess the drainage, color, texture, temperature, vascularity, condition of surrounding tissue and size of the area to be targeted for debridement.

Wound care codes 97597 to 97606 are intended to describe an entire debridement session, regardless of the number of wounds or areas you debride at the specific session. An exception to this would be if the same provider performed selective debridement at 2 distinctly separate sessions on the same date. For example, let's say a physician debrided a pressure sore of the right ankle and right hip in the morning. But due to the patient's condition, the physician selectively debrided the sacral pressure sore at a separate session that afternoon. In this case, you'd report 2 wound care management codes — one with modifier -59 — to identify procedures not normally reported together, but that are appropriate under the circumstance, and represent a different session or patient encounter and different site.

Size matters even more than ever when reporting wound debridements. With the deletion of CPT codes 11040 and 11041, you'll use these replacements to report subcutaneous skin debridements extending through the epidermis and dermis skin layers:

• 97597 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. Use CPT 97597 to report Versajet debridement of an ulcer since it uses pressurized sterile fluid to debride the wound.
• 97598 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; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure).

The remaining surgical debridement procedures underwent a descriptor change, whereby "first 20 sq cm or less" is now included in CPT codes 11042, 11043 and 11044. To report larger wounds, 3 add-on CPT codes have been included in the 2011 CPT book:

• 11045 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure).
• 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 code for primary procedure).
• 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 code for primary procedure).

CPT 11045 is an add-on code, reportable with CPT 11042. Report add-on CPT 11046 with CPT 11043. Report add-on CPT 11047 with CPT 11044. Don't report 97597 to 97602 with 11042 to 11047.

Fracture, dislocation debridement
Report fracture debridement codes 11010 to 11012 if the patient has a closed fracture. For example, in a traumatic fracture, the skin may be extensively damaged, causing massive involvement of the surrounding soft tissues and requiring significant debridement. However, the wound may not be involved down to the fracture.

• 11010 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.
• 11011 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.
• 11012 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.

If you debride more than one open fracture site, report the appropriate codes for debridement associated with open fracture(s) (11010 to 11012), with modifier -59 appended to the second procedure code. Modifier -59 indicates that a procedure or service was distinct or independent from other services performed on the same day.

Vacuum-assisted debridement
Negative pressure wound therapy is a procedure that manages wound exudates and promotes wound closure. The vacuum cleanses the wound and stimulates the wound bed, reduces localized edema and improves local oxygen supply. It places mechanical stress on the tissue that increases the rate of cellular proliferation, granular tissue formation and new vessel growth. Here are the codes:

• 97605 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters.
• 97606 Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters.