LCD/NCD Portal

L29128

 

WOUND DEBRIDEMENT SERVICES

 

 

01/01/2011

 

 

Indications and Limitations of Coverage and/or Medical Necessity

Medicare will consider debridement services medically reasonable and necessary when they are provided for the management of wounds and ulcers of the skin and underlying tissue to promote optimal wound healing or to prepare sites for appropriate surgical intervention.

• The requirements for reasonable and necessary service(s) include safe and effective debridement methods most appropriate to the type of wound, furnished in the appropriate setting, and ordered and/or performed by qualified personnel.

 

• Skin Debridement (CPT codes 11000-11001)

o CPT codes 11000 and 11001 describe removal of extensive eczematous or infected skin.

 Conditions that may require debridement of large amounts of skin include:

• Rapidly spreading necrotizing process (sometimes seen with aggressive streptococcal infections).

• Severe eczema.

• Bullous skin diseases.

• Extensive skin trauma (including large abraded areas with ground-in dirt).

• Autoimmune skin diseases (such as pemphigus).

o CPT code 11001 is NOT appropriate for debridement of a localized amount of tissue normally associated with a circumscribed lesion.

 Examples of this are:

• Ulcers.

• Furnucles.

• Localized skin infections.

• Debridement of Necrotizing Soft Tissue Infections (CPT codes 11004-11008)

o CPT codes 11004-11006 describe extensive debridement of:

 Skin.

 Subcutaneous tissue.

 Muscle.

 Fascia to treat necrotizing soft tissue infections.

• Generally, these debridement procedures are performed on high-risk patients.

• The code descriptor indicates the specific area that receives treatment.

o CPT code 11008 describes the concurrent removal of a mesh or prosthetic device.

• Surgical Debridement (CPT codes 11042-11047)

o Surgical debridement occurs only if material has been excised and is typically reported for the treatment of a wound to clear and maintain the site free of devitalized tissue including necrosis, eschar, slough, infected tissue, abnormal granulation tissue etc., to the margins of viable tissue.

 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 surgical instrument does not necessarily substantiate the performance of surgical excisional debridement.

 Unless the medical record shows that a surgical excision debridement has been performed, debridements should be coded with either selective or non-selective codes (97597, 97598, or 97602).]

o Surgical debridement codes (11042-11047), 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.

 These codes can be very effective but represent extensive debridement, often painful to the patient, and could require complex, surgical procedures and sometimes require the use of general anesthesia.

 Surgical debridement will be considered as “not medically necessary” when documentation indicates the wound is without infection, necrosis, or nonviable tissues and has pink to red granulated tissue.

o Documentation for surgical debridement procedures should include the indications for the procedure, the type of anesthesia if and when used, and the narrative of the procedure that describes the wounds, as well as the details of the debridement procedure itself.

 The CPT code selected should reflect the

• Level of debrided tissue.

o Skin

o Subcutaneous tissue.

o Muscle.

o Bone.

• NOT the extent, depth, of:

o Skin.

o Subcutaneous tissue.

o Muscle.

o Bone.

• Grade of the ulcer or wound.

 For example, CPT code 11042 defined as “Debridement; subcutaneous tissue” should be used if only necrotic subcutaneous tissue is debrided, even though the ulcer or wound might extend to the bone.

• In addition, if only fibrin is removed, this code would not be billed.

o It would not be expected that an individual wound would be repeatedly debrided of skin and subcutaneous tissue because these tissues do not regrow very quickly.

• Active Wound Care Management

o Debridement is indicated whenever necrotic tissue is present on an open wound.

o Debridement may also be indicated in cases of abnormal wound healing or repair.

o Debridement will not be considered a reasonable and necessary procedure for a wound that is clean and free of necrotic tissue.

o This procedure includes wound assessment; debridement; application of ointments, creams, sealants, and other wound coverings; and instructions for ongoing care.

o It should be billed no more than once per day, regardless of the number of wounds.

• Selective Debridement (97597 and 97598)

o CPT codes 97597 and 97598 are used for the removal of specific, targeted areas of devitalized or necrotic tissue from a wound along the margin of viable tissue.

o Occasional bleeding and pain may occur.

o The routine application of a topical or local anesthetic does not elevate active wound care management to surgical debridement.

o Selective debridement includes:

 Selective removal of necrotic tissue by sharp dissection including scissors, scalpel, and forceps.

 Selective removal of necrotic tissue by high pressure water jet.

• Medicare coverage for wound care on a continuing basis for a given wound in a given patient is contingent upon evidence documented in the patient’s medical record that the wound is improving in response to the wound care being provided.

o It is neither reasonable nor medically necessary to continue a given type of wound care if evidence of wound improvement cannot be shown.

• Evidence of improvement includes, but is not limited to, measurable changes in at least some of the following:

o Drainage (color, amount, consistency).

o Inflammation.

o Swelling.

o Pain.

o Wound dimensions (diameter, depth, tunneling).

o Granulation tissue.

o Necrotic tissue/slough.

• Such evidence must be documented with each visit.

o A wound that shows no improvement after 30 days requires a new approach, which may include a

 reassessment, by a qualified professional, of:

• Underlying infection problems inhibiting wound healing.

• Metabolic problems inhibiting wound healing.

• Nutritional problems inhibiting wound healing.

• Vascular problems inhibiting wound healing.

Or

 New plan of care or treatment method.

• In rare instances, the goal of wound care provided in the outpatient setting may only be to prevent progression of the wound, which due to severe underlying debility or other factors such as inoperability, is not expected to improve.

 

LIMITATIONS

FCSO Medicare does NOT consider the following services to be wound debridement:

• Removal of necrotic tissue by cleansing, scraping (other than by a scalpel or a curette), chemical application, and wet-to-dry dressing.

• Washing bacterial or fungal debris from lesions.

• Removal of secretions and coagulation serum from normal skin surrounding an ulcer.

• Dressing of small or superficial lesions.

• Removal of fibrinous material from the margin of an ulcer.

• Paring or cutting of corns or non-plantar calluses.

o Skin breakdown under a dorsal corn that begins to heal when the corn is removed and shoe pressure eliminated is not considered an ulcer and does not require debridement unless there is extension into the subcutaneous tissue.

• Incision and drainage of abscess including paronychia, trimming or debridement of mycotic nails, avulsion of nail plates, acne surgery, or destruction of warts.

o Providers should report these procedures, when they represent covered, reasonable and necessary services, using appropriate CPT or HCPCS codes.

 

 

CPT/HCPCS Codes

 

11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE

11001 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

11004 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSUE INFECTION; EXTERNAL GENITALIA AND PERINEUM

11005 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSUE INFECTION; ABDOMINAL WALL, WITH OR WITHOUT FASCIAL CLOSURE

11006 DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSUE INFECTION; 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 CODE FOR PRIMARY PROCEDURE)

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

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)

97597 DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, 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

97598 DEBRIDEMENT (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), OPEN WOUND, (EG, 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)

 

 

ICD-9 Codes that Support Medical Necessity

 

040.0 GAS GANGRENE

110.0 DERMATOPHYTOSIS OF SCALP AND BEARD

110.1 DERMATOPHYTOSIS OF NAIL

110.2 DERMATOPHYTOSIS OF HAND

110.3 DERMATOPHYTOSIS OF GROIN AND PERIANAL AREA

110.4 DERMATOPHYTOSIS OF FOOT

110.5 DERMATOPHYTOSIS OF THE BODY

110.6 DEEP SEATED DERMATOPHYTOSIS

110.8 DERMATOPHYTOSIS OF OTHER SPECIFIED SITES

110.9 DERMATOPHYTOSIS OF UNSPECIFIED SITE

440.23 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH ULCERATION

440.24 ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES WITH GANGRENE

443.9 PERIPHERAL VASCULAR DISEASE UNSPECIFIED

454.0 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER

454.2 VARICOSE VEINS OF LOWER EXTREMITIES WITH ULCER AND INFLAMMATION

569.41 ULCER OF ANUS AND RECTUM

608.4 OTHER INFLAMMATORY DISORDERS OF MALE GENITAL ORGANS

608.83 VASCULAR DISORDERS OF MALE GENITAL ORGANS

681.00 UNSPECIFIED CELLULITIS AND ABSCESS OF FINGER

681.01 FELON

681.02 ONYCHIA AND PARONYCHIA OF FINGER

681.10 UNSPECIFIED CELLULITIS AND ABSCESS OF TOE

681.11 ONYCHIA AND PARONYCHIA OF TOE

681.9 CELLULITIS AND ABSCESS OF UNSPECIFIED DIGIT

682.0 CELLULITIS AND ABSCESS OF FACE

682.1 CELLULITIS AND ABSCESS OF NECK

682.2 CELLULITIS AND ABSCESS OF TRUNK

682.3 CELLULITIS AND ABSCESS OF UPPER ARM AND FOREARM

682.4 CELLULITIS AND ABSCESS OF HAND EXCEPT FINGERS AND THUMB

682.5 CELLULITIS AND ABSCESS OF BUTTOCK

682.6 CELLULITIS AND ABSCESS OF LEG EXCEPT FOOT

682.7 CELLULITIS AND ABSCESS OF FOOT EXCEPT TOES

682.8 CELLULITIS AND ABSCESS OF OTHER SPECIFIED SITES

682.9 CELLULITIS AND ABSCESS OF UNSPECIFIED SITES

684 IMPETIGO

686.00 PYODERMA UNSPECIFIED

686.01 PYODERMA GANGRENOSUM

686.09 OTHER PYODERMA

686.1 PYOGENIC GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE

686.8 OTHER SPECIFIED LOCAL INFECTIONS OF SKIN AND SUBCUTANEOUS TISSUE

686.9 UNSPECIFIED LOCAL INFECTION OF SKIN AND SUBCUTANEOUS TISSUE

692.0 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO DETERGENTS

692.1 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO OILS AND GREASES

692.2 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO SOLVENTS

692.3 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO DRUGS AND MEDICINES IN CONTACT WITH SKIN

692.4 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO OTHER CHEMICAL PRODUCTS

692.5 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO FOOD IN CONTACT WITH SKIN

692.6 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO PLANTS (EXCEPT FOOD)

692.81 DERMATITIS DUE TO COSMETICS

692.82 DERMATITIS DUE TO OTHER RADIATION

692.83 DERMATITIS DUE TO METALS

692.84 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO ANIMAL (CAT) (DOG) DANDER

692.89 CONTACT DERMATITIS AND OTHER ECZEMA DUE TO OTHER SPECIFIED AGENTS

692.9 CONTACT DERMATITIS AND OTHER ECZEMA UNSPECIFIED CAUSE

707.00 PRESSURE ULCER, UNSPECIFIED SITE

707.01 PRESSURE ULCER, ELBOW

707.02 PRESSURE ULCER, UPPER BACK

707.03 PRESSURE ULCER, LOWER BACK

707.04 PRESSURE ULCER, HIP

707.05 PRESSURE ULCER, BUTTOCK

707.06 PRESSURE ULCER, ANKLE

707.07 PRESSURE ULCER, HEEL

707.09 PRESSURE ULCER, OTHER SITE

707.10 UNSPECIFIED ULCER OF LOWER LIMB

707.11 ULCER OF THIGH

707.12 ULCER OF CALF

707.13 ULCER OF ANKLE

707.14 ULCER OF HEEL AND MIDFOOT

707.15 ULCER OF OTHER PART OF FOOT

707.19 ULCER OF OTHER PART OF LOWER LIMB

707.20 PRESSURE ULCER, UNSPECIFIED STAGE

707.21 PRESSURE ULCER, STAGE I

707.22 PRESSURE ULCER, STAGE II

707.23 PRESSURE ULCER, STAGE III

707.24 PRESSURE ULCER, STAGE IV

707.25 PRESSURE ULCER, UNSTAGEABLE

707.8 CHRONIC ULCER OF OTHER SPECIFIED SITES

707.9 CHRONIC ULCER OF UNSPECIFIED SITE

709.4 FOREIGN BODY GRANULOMA OF SKIN AND SUBCUTANEOUS TISSUE

709.8 OTHER SPECIFIED DISORDERS OF SKIN

728.86 NECROTIZING FASCIITIS

730.10 CHRONIC OSTEOMYELITIS SITE UNSPECIFIED

730.11 CHRONIC OSTEOMYELITIS INVOLVING SHOULDER REGION

730.12 CHRONIC OSTEOMYELITIS INVOLVING UPPER ARM

730.13 CHRONIC OSTEOMYELITIS INVOLVING FOREARM

730.14 CHRONIC OSTEOMYELITIS INVOLVING HAND

730.15 CHRONIC OSTEOMYELITIS INVOLVING PELVIC REGION AND THIGH

730.16 CHRONIC OSTEOMYELITIS INVOLVING LOWER LEG

730.17 CHRONIC OSTEOMYELITIS INVOLVING ANKLE AND FOOT

730.18 CHRONIC OSTEOMYELITIS INVOLVING OTHER SPECIFIED SITES

730.19 CHRONIC OSTEOMYELITIS INVOLVING MULTIPLE SITES

785.4 GANGRENE

870.0 LACERATION OF SKIN OF EYELID AND PERIOCULAR AREA

870.1 LACERATION OF EYELID FULL-THICKNESS NOT INVOLVING LACRIMAL PASSAGES

870.2 LACERATION OF EYELID INVOLVING LACRIMAL PASSAGES

872.00 OPEN WOUND OF EXTERNAL EAR UNSPECIFIED SITE UNCOMPLICATED

872.01 OPEN WOUND OF AURICLE UNCOMPLICATED

872.02 OPEN WOUND OF AUDITORY CANAL UNCOMPLICATED

872.10 OPEN WOUND OF EXTERNAL EAR UNSPECIFIED SITE COMPLICATED

872.11 OPEN WOUND OF AURICLE COMPLICATED

872.12 OPEN WOUND OF AUDITORY CANAL COMPLICATED

873.0 OPEN WOUND OF SCALP WITHOUT COMPLICATION

873.1 OPEN WOUND OF SCALP COMPLICATED

873.20 OPEN WOUND OF NOSE UNSPECIFIED SITE UNCOMPLICATED

873.21 OPEN WOUND OF NASAL SEPTUM UNCOMPLICATED

873.22 OPEN WOUND OF NASAL CAVITY UNCOMPLICATED

873.23 OPEN WOUND OF NASAL SINUS UNCOMPLICATED

873.29 OPEN WOUND OF MULTIPLE SITES UNCOMPLICATED

873.30 OPEN WOUND OF NOSE UNSPECIFIED SITE COMPLICATED

873.31 OPEN WOUND OF NASAL SEPTUM COMPLICATED

873.32 OPEN WOUND OF NASAL CAVITY COMPLICATED

873.33 OPEN WOUND OF NASAL SINUS COMPLICATED

873.39 OPEN WOUND OF MULTIPLE SITES COMPLICATED

873.40 OPEN WOUND OF FACE UNSPECIFIED SITE UNCOMPLICATED

873.41 OPEN WOUND OF CHEEK UNCOMPLICATED

873.42 OPEN WOUND OF FOREHEAD UNCOMPLICATED

873.43 OPEN WOUND OF LIP UNCOMPLICATED

873.44 OPEN WOUND OF JAW UNCOMPLICATED

873.49 OPEN WOUND OF OTHER AND MULTIPLE SITES UNCOMPLICATED

873.50 OPEN WOUND OF FACE UNSPECIFIED SITE COMPLICATED

873.51 OPEN WOUND OF CHEEK COMPLICATED

873.52 OPEN WOUND OF FOREHEAD COMPLICATED

873.53 OPEN WOUND OF LIP COMPLICATED

873.54 OPEN WOUND OF JAW COMPLICATED

873.59 OPEN WOUND OF OTHER AND MULTIPLE SITES COMPLICATED

873.60 OPEN WOUND OF MOUTH UNSPECIFIED SITE UNCOMPLICATED

873.61 OPEN WOUND OF BUCCAL MUCOSA UNCOMPLICATED

873.70 OPEN WOUND OF MOUTH UNSPECIFIED SITE COMPLICATED

873.71 OPEN WOUND OF BUCCAL MUCOSA COMPLICATED

873.72 OPEN WOUND OF GUM (ALVEOLAR PROCESS) COMPLICATED

873.74 OPEN WOUND OF TONGUE AND FLOOR OF MOUTH COMPLICATED

873.75 OPEN WOUND OF PALATE COMPLICATED

873.79 OPEN WOUND OF OTHER AND MULTIPLE SITES COMPLICATED

873.8 OTHER AND UNSPECIFIED OPEN WOUND OF HEAD WITHOUT COMPLICATION

873.9 OTHER AND UNSPECIFIED OPEN WOUND OF HEAD COMPLICATED

874.00 OPEN WOUND OF LARYNX WITH TRACHEA UNCOMPLICATED

874.01 OPEN WOUND OF LARYNX UNCOMPLICATED

874.02 OPEN WOUND OF TRACHEA UNCOMPLICATED

874.10 OPEN WOUND OF LARYNX WITH TRACHEA COMPLICATED

874.11 OPEN WOUND OF LARYNX COMPLICATED

874.12 OPEN WOUND OF TRACHEA COMPLICATED

874.2 OPEN WOUND OF THYROID GLAND WITHOUT COMPLICATION

874.3 OPEN WOUND OF THYROID GLAND COMPLICATED

874.4 OPEN WOUND OF PHARYNX WITHOUT COMPLICATION

874.5 OPEN WOUND OF PHARYNX COMPLICATED

874.8 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF NECK WITHOUT COMPLICATION

874.9 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF NECK COMPLICATED

875.0 OPEN WOUND OF CHEST (WALL) WITHOUT COMPLICATION

875.1 OPEN WOUND OF CHEST (WALL) COMPLICATED

876.0 OPEN WOUND OF BACK WITHOUT COMPLICATION

876.1 OPEN WOUND OF BACK COMPLICATED

877.0 OPEN WOUND OF BUTTOCK WITHOUT COMPLICATION

877.1 OPEN WOUND OF BUTTOCK COMPLICATED

878.0 OPEN WOUND OF PENIS WITHOUT COMPLICATION

878.1 OPEN WOUND OF PENIS COMPLICATED

878.2 OPEN WOUND OF SCROTUM AND TESTES WITHOUT COMPLICATION

878.3 OPEN WOUND OF SCROTUM AND TESTES COMPLICATED

878.4 OPEN WOUND OF VULVA WITHOUT COMPLICATION

878.5 OPEN WOUND OF VULVA COMPLICATED

878.6 OPEN WOUND OF VAGINA WITHOUT COMPLICATION

878.7 OPEN WOUND OF VAGINA COMPLICATED

878.8 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF GENITAL ORGANS WITHOUT COMPLICATION

878.9 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF GENITAL ORGANS COMPLICATED

879.0 OPEN WOUND OF BREAST WITHOUT COMPLICATION

879.1 OPEN WOUND OF BREAST COMPLICATED

879.2 OPEN WOUND OF ABDOMINAL WALL ANTERIOR WITHOUT COMPLICATION

879.3 OPEN WOUND OF ABDOMINAL WALL ANTERIOR COMPLICATED

879.4 OPEN WOUND OF ABDOMINAL WALL LATERAL WITHOUT COMPLICATION

879.5 OPEN WOUND OF ABDOMINAL WALL LATERAL COMPLICATED

879.6 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF TRUNK WITHOUT COMPLICATION

879.7 OPEN WOUND OF OTHER AND UNSPECIFIED PARTS OF TRUNK COMPLICATED

879.8 OPEN WOUND(S) (MULTIPLE) OF UNSPECIFIED SITE(S) WITHOUT COMPLICATION

879.9 OPEN WOUND(S) (MULTIPLE) OF UNSPECIFIED SITE(S) COMPLICATED

880.00 OPEN WOUND OF SHOULDER REGION WITHOUT COMPLICATION

880.01 OPEN WOUND OF SCAPULAR REGION WITHOUT COMPLICATION

880.02 OPEN WOUND OF AXILLARY REGION WITHOUT COMPLICATION

880.03 OPEN WOUND OF UPPER ARM WITHOUT COMPLICATION

880.09 OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITHOUT COMPLICATION

880.10 OPEN WOUND OF SHOULDER REGION COMPLICATED

880.11 OPEN WOUND OF SCAPULAR REGION COMPLICATED

880.12 OPEN WOUND OF AXILLARY REGION COMPLICATED

880.13 OPEN WOUND OF UPPER ARM COMPLICATED

880.19 OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM COMPLICATED

880.20 OPEN WOUND OF SHOULDER REGION WITH TENDON INVOLVEMENT

880.21 OPEN WOUND OF SCAPULAR REGION WITH TENDON INVOLVEMENT

880.22 OPEN WOUND OF AXILLARY REGION WITH TENDON INVOLVEMENT

880.23 OPEN WOUND OF UPPER ARM WITH TENDON INVOLVEMENT

880.29 OPEN WOUND OF MULTIPLE SITES OF SHOULDER AND UPPER ARM WITH TENDON INVOLVEMENT

881.00 OPEN WOUND OF FOREARM WITHOUT COMPLICATION

881.01 OPEN WOUND OF ELBOW WITHOUT COMPLICATION

881.02 OPEN WOUND OF WRIST WITHOUT COMPLICATION

881.10 OPEN WOUND OF FOREARM COMPLICATED

881.11 OPEN WOUND OF ELBOW COMPLICATED

881.12 OPEN WOUND OF WRIST COMPLICATED

881.20 OPEN WOUND OF FOREARM WITH TENDON INVOLVEMENT

881.21 OPEN WOUND OF ELBOW WITH TENDON INVOLVEMENT

881.22 OPEN WOUND OF WRIST WITH TENDON INVOLVEMENT

882.0 OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITHOUT COMPLICATION

882.1 OPEN WOUND OF HAND EXCEPT FINGERS ALONE COMPLICATED

882.2 OPEN WOUND OF HAND EXCEPT FINGERS ALONE WITH TENDON INVOLVEMENT

883.0 OPEN WOUND OF FINGERS WITHOUT COMPLICATION

883.1 OPEN WOUND OF FINGERS COMPLICATED

883.2 OPEN WOUND OF FINGERS WITH TENDON INVOLVEMENT

884.0 MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITHOUT COMPLICATION

884.1 MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB COMPLICATED

884.2 MULTIPLE AND UNSPECIFIED OPEN WOUND OF UPPER LIMB WITH TENDON INVOLVEMENT

885.0 TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) WITHOUT COMPLICATION

885.1 TRAUMATIC AMPUTATION OF THUMB (COMPLETE)(PARTIAL) COMPLICATED

886.0 TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION

886.1 TRAUMATIC AMPUTATION OF OTHER FINGER(S) (COMPLETE) (PARTIAL) COMPLICATED

887.0 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL BELOW ELBOW WITHOUT COMPLICATION

887.1 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL BELOW ELBOW COMPLICATED

887.2 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL AT OR ABOVE ELBOW WITHOUT COMPLICATION

887.3 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL AT OR ABOVE ELBOW COMPLICATED

887.4 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL LEVEL NOT SPECIFIED WITHOUT COMPLICATION

887.5 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) UNILATERAL LEVEL NOT SPECIFIED COMPLICATED

887.6 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) WITHOUT COMPLICATION

887.7 TRAUMATIC AMPUTATION OF ARM AND HAND (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED

890.0 OPEN WOUND OF HIP AND THIGH WITHOUT COMPLICATION

890.1 OPEN WOUND OF HIP AND THIGH COMPLICATED

890.2 OPEN WOUND OF HIP AND THIGH WITH TENDON INVOLVEMENT

891.0 OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITHOUT COMPLICATION

891.1 OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE COMPLICATED

891.2 OPEN WOUND OF KNEE LEG (EXCEPT THIGH) AND ANKLE WITH TENDON INVOLVEMENT

892.0 OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITHOUT COMPLICATION

892.1 OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE COMPLICATED

892.2 OPEN WOUND OF FOOT EXCEPT TOE(S) ALONE WITH TENDON INVOLVEMENT

893.0 OPEN WOUND OF TOE(S) WITHOUT COMPLICATION

893.1 OPEN WOUND OF TOE(S) COMPLICATED

893.2 OPEN WOUND OF TOE(S) WITH TENDON INVOLVEMENT

895.0 TRAUMATIC AMPUTATION OF TOE(S) (COMPLETE) (PARTIAL) WITHOUT COMPLICATION

895.1 TRAUMATIC AMPUTATION OF TOE(S) (COMPLETE) (PARTIAL) COMPLICATED

896.0 TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) UNILATERAL WITHOUT COMPLICATION

896.1 TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) UNILATERAL COMPLICATED

896.2 TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) BILATERAL WITHOUT COMPLICATION

896.3 TRAUMATIC AMPUTATION OF FOOT (COMPLETE) (PARTIAL) BILATERAL COMPLICATED

897.0 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL BELOW KNEE WITHOUT COMPLICATION

897.1 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL BELOW KNEE COMPLICATED

897.2 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL AT OR ABOVE KNEE WITHOUT COMPLICATION

897.3 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL AT OR ABOVE KNEE COMPLICATED

897.4 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL LEVEL NOT SPECIFIED WITHOUT COMPLICATION

897.5 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) UNILATERAL LEVEL NOT SPECIFIED COMPLICATED

897.6 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) WITHOUT COMPLICATION

897.7 TRAUMATIC AMPUTATION OF LEG(S) (COMPLETE) (PARTIAL) BILATERAL (ANY LEVEL) COMPLICATED

941.20 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF FACE AND HEAD UNSPECIFIED SITE

941.21 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF EAR (ANY PART)

941.22 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF EYE (WITH OTHER PARTS OF FACE HEAD AND NECK)

941.23 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF LIP(S)

941.24 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF CHIN

941.25 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF NOSE (SEPTUM)

941.26 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF SCALP (ANY PART)

941.27 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF FOREHEAD AND CHEEK

941.28 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF NECK

941.29* BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES (EXCEPT WITH EYE) OF FACE HEAD AND NECK

941.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF FACE AND HEAD

941.31 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF EAR (ANY PART)

941.32 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF EYE (WITH OTHER PARTS OF FACE HEAD AND NECK)

941.33 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF LIP(S)

941.34 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF CHIN

941.35 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF NOSE (SEPTUM)

941.36 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SCALP (ANY PART)

941.37 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF FOREHEAD AND CHEEK

941.38 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF NECK

941.39* FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES (EXCEPT WITH EYE) OF FACE HEAD AND NECK

941.40 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF FACE AND HEAD WITHOUT LOSS OF BODY PART

941.41 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF EAR (ANY PART) WITHOUT LOSS OF EAR

941.42 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF EYE (WITH OTHER PARTS OF FACE HEAD AND NECK) WITHOUT LOSS OF BODY PART

941.43 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF LIP(S) WITHOUT LOSS OF LIP(S)

941.44 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF CHIN WITHOUT LOSS OF CHIN

941.45 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF NOSE (SEPTUM) WITHOUT LOSS OF NOSE

941.46 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SCALP (ANY PART) WITHOUT LOSS OF SCALP

941.47 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF FOREHEAD AND CHEEK WITHOUT LOSS OF FOREHEAD AND CHEEK

941.48 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF NECK WITHOUT LOSS OF NECK

941.49* DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES (EXCEPT WITH EYE) OF FACE HEAD AND NECK WITHOUT LOSS OF A BODY PART

942.20 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF TRUNK

942.21 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF BREAST

942.22 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF CHEST WALL EXCLUDING BREAST AND NIPPLE

942.23 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF ABDOMINAL WALL

942.24 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF BACK (ANY PART)

942.25 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF GENITALIA

942.29* BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF OTHER AND MULTIPLE SITES OF TRUNK

942.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF TRUNK

942.31 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF BREAST

942.32 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF CHEST WALL EXCLUDING BREAST AND NIPPLE

942.33 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF ABDOMINAL WALL

942.34 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF BACK (ANY PART)

942.35 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF GENITALIA

942.39* FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF OTHER AND MULTIPLE SITES OF TRUNK

942.40 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF TRUNK UNSPECIFIED SITE WITHOUT LOSS OF BODY PART

942.41 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF BREAST WITHOUT LOSS OF BREAST

942.42 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF CHEST WALL EXCLUDING BREAST AND NIPPLE WITHOUT LOSS OF CHEST WALL

942.43 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF ABDOMINAL WALL WITHOUT LOSS OF ABDOMINAL WALL

942.44 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF BACK (ANY PART) WITHOUT LOSS OF BACK

942.45 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF GENITALIA WITHOUT LOSS OF GENITALIA

942.49* DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF OTHER AND MULTIPLE SITES OF TRUNK WITHOUT LOSS OF BODY PART

943.20 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB

943.21 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF FOREARM

943.22 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF ELBOW

943.23 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UPPER ARM

943.24 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF AXILLA

943.25 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF SHOULDER

943.26 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF SCAPULAR REGION

943.29* BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF UPPER LIMB

943.31 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF FOREARM

943.32 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF ELBOW

943.33 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UPPER ARM

943.34 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF AXILLA

943.35 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SHOULDER

943.36 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SCAPULAR REGION

943.39* FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND

943.40 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF UPPER LIMB WITHOUT LOSS OF A BODY PART

943.41 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF FOREARM WITHOUT LOSS OF FOREARM

943.42 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF ELBOW WITHOUT LOSS OF ELBOW

943.43 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UPPER ARM WITHOUT LOSS OF UPPER ARM

943.44 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN OF AXILLA WITHOUT LOSS OF AXILLA

943.45 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SHOULDER WITHOUT LOSS OF SHOULDER

943.46 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SCAPULAR REGION WITHOUT LOSS OF SCAPULA

943.49* DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF UPPER LIMB EXCEPT WRIST AND HAND WITHOUT LOSS OF UPPER LIMB

944.20 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF UNSPECIFIED SITE OF HAND

944.21 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF SINGLE DIGIT (FINGER (NAIL)) OTHER THAN THUMB

944.22 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN OF (SECOND DEGREE) OF THUMB (NAIL)

944.23 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF TWO OR MORE DIGITS OF HAND NOT INCLUDING THUMB

944.24 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF TWO OR MORE DIGITS OF HAND INCLUDING THUMB

944.25 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF PALM OF HAND

944.26 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF BACK OF HAND

944.27 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF WRIST

944.28* BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

944.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF HAND

944.31 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF SINGLE DIGIT (FINGER (NAIL)) OTHER THAN THUMB

944.32 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF THUMB (NAIL)

944.33 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF TWO OR MORE DIGITS OF HAND NOT INCLUDING THUMB

944.34 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF TWO OR MORE DIGITS OF HAND INCLUDING THUMB

944.35 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF PALM OF HAND

944.36 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF BACK OF HAND

944.37 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF WRIST

944.38* FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF WRIST(S) AND HAND(S)

944.40 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF HAND WITHOUT LOSS OF HAND

944.41 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF SINGLE DIGIT (FINGER (NAIL)) OTHER THAN THUMB WITHOUT LOSS OF FINGER

944.42 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF THUMB (NAIL) WITHOUT LOSS OF THUMB

944.43 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF TWO OR MORE DIGITS OF HAND NOT INCLUDING THUMB WITHOUT FINGERS

944.44 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF TWO OR MORE DIGITS OF HAND INCLUDING THUMB WITHOUT LOSS OF FINGERS

944.45 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF PALM OF HAND WITHOUT LOSS OF PALM

944.46 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF BACK OF HAND WITHOUT LOSS OF BACK OF HAND

944.47 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF WRIST WITHOUT LOSS OF WRIST

944.48* DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF WRIST(S) AND HAND(S) WITHOUT LOSS OF A BODY PART

945.20 BLISTERS EPIDERMAL LOSS (SECOND DEGREE) OF UNSPECIFIED SITE OF LOWER LIMB (LEG)

945.21 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF TOE(S) (NAIL)

945.22 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF FOOT

945.23 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF ANKLE

945.24 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF LOWER LEG

945.25 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF KNEE

945.26 BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF THIGH (ANY PART)

945.29* BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S)

945.30 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF UNSPECIFIED SITE OF LOWER LIMB

945.31 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF TOE(S) (NAIL)

945.32 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF FOOT

945.33 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF ANKLE

945.34 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF LOWER LEG

945.35 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF KNEE

945.36 FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF THIGH (ANY PART)

945.39* FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SITES OF LOWER LIMB(S)

945.40 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF UNSPECIFIED SITE OF LOWER LIMB (LEG) WITHOUT LOSS OF A BODY PART

945.41 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF TOE(S) (NAIL) WITHOUT LOSS OF TOE(S)

945.42 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF FOOT WITHOUT LOSS OF FOOT

945.43 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF ANKLE WITHOUT LOSS OF ANKLE

945.44 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF LOWER LEG WITHOUT LOSS OF LOWER LEG

945.45 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF KNEE WITHOUT LOSS OF KNEE

945.46 DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF THIGH (ANY PART) WITHOUT LOSS OF THIGH

945.49* DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SITES OF LOWER LIMB(S) WITHOUT LOSS OF A BODY PART

946.2* BLISTERS WITH EPIDERMAL LOSS DUE TO BURN (SECOND DEGREE) OF MULTIPLE SPECIFIED SITES

946.3* FULL-THICKNESS SKIN LOSS DUE TO BURN (THIRD DEGREE NOS) OF MULTIPLE SPECIFIED SITES

946.4* DEEP NECROSIS OF UNDERLYING TISSUES DUE TO BURN (DEEP THIRD DEGREE) OF MULTIPLE SPECIFIED SITES WITHOUT LOSS OF A BODY PART

958.3 POSTTRAUMATIC WOUND INFECTION NOT ELSEWHERE CLASSIFIED

997.60 UNSPECIFIED LATE COMPLICATION OF AMPUTATION STUMP

997.62 INFECTION (CHRONIC) OF AMPUTATION STUMP

998.30 DISRUPTION OF WOUND, UNSPECIFIED

998.31 DISRUPTION OF INTERNAL OPERATION (SURGICAL) WOUND

998.32 DISRUPTION OF EXTERNAL OPERATION (SURGICAL) WOUND

998.33 DISRUPTION OF TRAUMATIC INJURY WOUND REPAIR

998.59 OTHER POSTOPERATIVE INFECTION

998.83 NON-HEALING SURGICAL WOUND

* These additional ICD-9-CM codes are to be used with CPT codes 97597 and 97598 only.

 

Documentation Requirements

• Medical record documentation maintained by the performing provider must clearly indicate the medical necessity of the service being billed.

• The medical record must include the following information and be available to Medicare upon request:

o An operative note or procedure note for the debridement service(s).

o This note should describe the anatomical location treated, the instruments used, anesthesia used if required, the type of tissue removed from the wound, the depth and area of the wound and the immediate post-op care and follow-up instructions.

o Identification of the wound location, size, depth and stage by description and may include a drawing or photograph.

o A description of the type(s) of tissue involvement:

 Severity of tissue destruction.

 Undermining or tunneling.

 Necrosis.

 Infection.

 Evidence of reduced circulation.

o A pathology report when billing for the debridement procedure described by CPT code 11044.

• In addition, except for patients with compromised healing due to severe underlying debility or other factors, documentation in the medical record must show:

o The status of the wound is such that the treatment is expected to make a significant practical improvement in the wound in a reasonable and generally predictable period of time.

o There is an expectation that the treatment will substantially affect tissue healing and viability, reduce or control tissue infection, remove necrotic tissue or prepare the tissue for surgical management.

o The patient’s expected restoration potential must be significant in relation to the extent and duration of treatment required [in] achieving this potential. If wound closure is not a goal, then the expectation is to optimize recovery and establish an appropriate non-skilled maintenance program.

• Active wound care management performed by a physical or occupational therapist must be performed under a certified plan of care as any other therapy service outlining:

o Specific goals.

o Duration.

o Frequency.

o Modalities.

o An anticipated endpoint.

o Other pertinent factors as they may apply.

o Departure from this plan must be documented.

 

 

Utilization Guidelines

• The appropriate interval and frequency of debridement depends on the individual clinical characteristics of patients and the extent of the wound.

o Reduction of pressure and/or control of infection will facilitate healing and may reduce the need for repeated debridement services.

o The treatment plan for a patient who requires frequent repeated debridement should be reevaluated to ensure that pressure reduction and infection control have been adequately addressed.

• Debridement services are not considered to be medically necessary when performed more frequently than once a week.

o The rationale and medical justification for more frequent services must be clearly documented in the medical record.

o If the debridement of chronic ulcers require more than EIGHT total services for any of the debridement codes listed in this LCD (CPT codes 11000-97598), the rationale and medical justification for this utilization, on a given day or over time, must be specifically addressed in the medical record.

 

 

Treatment Logic

• Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound.

• Debridement promotes wound healing by reducing sources of infection and other mechanical impediments to healing.

 

 

Sources of Information and Basis for Decision

 

Ayello, E., & Cuddigan, J. (2004). Debridement: Controlling the necrotic/cellular burden. Advances in Skin & Wound Care, 17:66-78.

 

Black, J., Baharestani, M., Cuddigan, J., Dorner, B., Edsberg, L., Langemo, D., & et al. (2007). National pressure ulcer advisory panel’s updated pressure ulcer staging system. Dermatology Nursing. 19(4): 343-349.

 

Choucair, M. M., Fivenson, D. P. (2001). Leg ulcer diagnosis and management. Retrieved March 19, 2002 from http://homeconsult.com/das/article/body/1/jorg=journal&source=MI&sp=12040563&sid This reference provided information surrounding appropriate diagnoses criteria.

 

CPT Assistant – June 2005 & October 2007

 

CPT Changes: An Insider’s View – 2005, & 2008, 2011

 

Debridement. (2004). Body1, Inc. Retrieved October 6, 2008 from http://www.wounds1.com/care/procedure20.cfm/19

 

Deery, H. G., & Sangererozan, J. A. (2001). Saving the diabetic foot with special reference to the patient with chronic renal failure. Retrieved March 19, 2002 from http://home.mdconsult.com/das/article/body/1/jorg=journal&source=MI&sp=11974766&sid This reference provided definitions and indications for wound management.

 

FCSO LCD 29128, Wound Debridement Services, 01/01/2011. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Fife, C. (2008). The debridement predicament. Retrieved October 6, 2008 from: http://www.intellicure.com/News/2008_01-02_Pulse/debridement _predicament.htm

 

Lewis, R., Whiting, P., ter Riet, G., O’Meara S., & Glanville, J. (2001). A rapid and systemic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention. Retrieved March 19, 2002 from http://home.mdconsult.com/das/citation/body/jorg=journal&source=MI&sp=11892394&sid This reference provided expectations of treatments for wounds.

 

Other Medicare Contractors’ LCDs.

 

Paquette, D., & Fatanga, V. (2002). Leg ulcers. Retrieved March 19, 2002 from http://home.mdconsult.com/das/article/body/1/jorg=journal&source=&sp=12074980&sid This reference provided descriptions and treatments for leg wounds.

 

Salcido, R., & Popescu, A. (2006). Pressure ulcers and wound care. Retrieved October 1, 2008 from : http://www.emedicine.com/pmr/TOPIC179.HTM

 

Schaum, K. (2006). Newly funded selective and non-selective debridement CPT codes: Impact on hospital-owned outpatient wound care departments. Healthpoint, Inc. Retrieved October 1, 2008 from: http://www.woundsresearch.com/docs/Healthpoint_August.pdf

 

Stillman, R. (2008). Diabetic ulcers. Retrieved October 2, 2008 from : http://www.emedicine.com/med/TOPIC551.HTM

 

Suzuki, K. & Cowan, L. (2009). Current concepts in wound debridement. Podiatry Today, 22(7) July 1.

 

Tatsioni, A., Balk, E., O’Donnell, T., Lau, J. (2007). Usual care in the management of chronic wounds: A review of the recent literature. Journal of the American College of Surgeons, 205(4).

 

Ulcer. (2008). New World Encyclopedia. Retrieved October 2, 2008 from http://www.newworldencyclopedia.org/entry/Ulcer?oldid=683900

 

Valencia, I., Falabella, A., Kirsner, R. S., & Eaglstein, W. E. (2001). Chronic venous insufficiency and venous leg ulceration. Retrieved March 19, 2002 from http:/home.mdconsult.com/das/article/body/1/jorg=journal&source=MI&sp=11546251&sid This reference defined and discussed debridement and other treatment modalities.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

CMS LCD WOUND DEBRIDEMENT SERVICES