Coding for Open Fracture Debridement

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Coding for Open Fracture Debridement
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.
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Coding for Open Fracture Debridement
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 1104211047 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.
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Coding for Open Fracture Debridement

• 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 1101011012 can be used for
  debridements 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.

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Coding for Open Fracture Debridement

• 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
  (1101111012) 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
  1104211047 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 physicians documentation mus
  t support the code function.

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Coding for Open Fracture Debridement
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.
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Coding for Open Fracture Debridement
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). Struggling with Open Fracture
Debridement Coding? Get our easy guide to master
the correct codes. For expert help with billing
and coding, contact Medical Billers and Coders
(MBC) at 888-357-3226 or email us
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