Billing for complex surgical procedures can often feel like performing surgery with a blindfold. Why? Because the stakes are high! Coding errors and billing ambiguity may lead to significant revenue loss and compliance issues.
Therefore, successfully billing these complex services, such as the surgical debridement of bone tissue, requires absolution precision. This guide will help you acquire a deep understanding of specific CPT code 11044 reimbursement guidelines, its applicable modifiers, and real-world clinical scenarios.
Thus, if you are a wound care facility struggling to capture your rightful reimbursement, this guide is for you! Read it till the end to equip yourself with the necessary knowledge and smoothly navigate the billing intricacies surrounding CPT 11044.
CPT Code 11044 – Description
CPT code 11044 is from the ‘Debridement Procedures on the Skin’ code range. Like all other CPT code ranges, the American Medical Association (AMA) maintains it.
It reports the surgical removal of dead, infected tissue in the bone, along with the dermis, epidermis, muscle, subcutaneous tissue, and fascia, as needed. You can bill this code for the first 20 cm² or less of the debrided area.
Scenarios Where CPT Code 11044 is Applicable
Let’s take a look at a few clinical scenarios where CPT 11044 applies:
Localized Osteomyelitis Due to Open Fracture
Picture a 26-year-old male patient who visits the clinic 6 months after a tibia fracture repair. He developed a localized surgical site infection. Therefore, the physician ordered an MRI, and the images confirmed a small area of osteomyelitis (bone infection) at the fracture site with non-viable bone.
As a result, the healthcare professional performs a focused debridement to remove infected soft tissues along with the identified segment of necrotic cortical bone. The total area covered an area of 9 cm². Thus, CPT code 11044 applies.
Diabetic Foot Ulcer with Osteomyelitis
Consider a 59-year-old female patient with poorly controlled diabetes. She visits the clinic with a chronic, non-healing neuropathic ulcer on the plantar aspect of her right foot, i.e., beneath the first metatarsal head.
Imaging studies confirm osteomyelitis. Therefore, the physician performs a surgical debridement, excising necrotic skin, subcutaneous tissue, and infected superficial bone. The total treated area measures approximately 15 cm². Thus, CPT code 11044 applies.
Periprosthetic Joint Infection with Exposed Necrotic Bone
Imagine a 48-year-old male patient who visits the clinic with a chronic, draining sinus tract near a previously placed knee prosthesis. Imaging studies reveal a localized periprosthetic joint infection with a small segment of exposed necrotic bone adjacent to the implant.
Therefore, the clinician debrides the sinus tract, the surrounding soft tissue, and the identified area of necrotic bone. The total treated area measures around 16 cm². Thus, CPT code 11044 applies.
Applicable Modifiers for CPT Code 11044
Discussed below is the list of applicable modifiers for the surgical debridement of bone covering an area of 20 cm² or less:
Modifier 59 & X{EPSU}
What happens when the healthcare provider performs the surgical debridement of bone and tissue at two separate wound locations during the same encounter? You append modifier 59 to indicate that both debridements are distinct and separately identifiable.
However, note that you cannot use modifier 59 when another modifier more specifically defines why a procedure is eligible for a separate reimbursement. The U.S. Centers for Medicare and Medicaid Services (CMS) introduced modifiers X{EPSU}, which are subsets of modifier 59, to avoid its misuse and overuse. These subsets offer greater coding specificity, leading to timely reimbursements.
Here’s a brief description of when you can use these modifiers with CPT code 11044:
- XE (Separate Encounter) – Use this modifier when the debridement occurs in a separate patient encounter.
- XP (Separate Practitioner) – When a different physician conducts the surgical debridement, append modifier XP with CPT 11044.
- XS (Separate Structure) – Append modifier XS if the bone debridement covered under CPT 11044 is performed on a distinct anatomical site or lesion.
- XU (Unusual, Non-overlapping) – You can use it in cases when the components of the debridement procedure (CPT code 11044) are distinct and do not overlap with the previously performed procedure.
CPT Code 11044 – Billing & Reimbursement Guidelines
The following are the essential billing requirements related to CPT code 11044:
Do Not Bill CPT 11044 Alone When the Area Is Greater Than 20 cm²
What happens when the area where the healthcare provider performs surgical debridement of bone is greater than 20 cm²? You can report the initial 20 cm² with CPT code 11044 (primary code), and for each additional 20 cm², you can bill subsequent units of CPT code 11047 (add-on code)
Calculate Billable Area Carefully to Avoid Upcoding & Undercoding
Remember that debridement codes require you to measure the surface area of the debrided wound (length x width in cm²). Thus, its proper calculation is key to ensuring fair reimbursement.
CPT code 11044 covers only the first 20 cm² or less of debridement, including bone. For each additional cm², you can bill CPT code 11047, as we have already discussed.
Now, let’s take a look at an example to understand how it works to avoid upcoding and undercoding.
For instance, a clinician debrided an area of 18 cm in length and 12 cm in width, including the bone. The total billable area will be (18 x 12 = 216) 216 cm².
Correct coding will be to report 1 unit of 11044 for the initial 20 cm² and 10 units of 11047 for the remaining 196 cm².
How? Because 196 cm² requires nine units of 11047 (9 x 20 = 180 cm²) plus an additional unit for the last 16 cm², making it a total of 10 units.
Therefore, 11044 (20 cm²) + 11047 x 10 (200 cm²) = 220 cm² which covers 216 cm².
Ensure Detailed Documentation
Detailed and accurate documentation is essential to demonstrate the medical necessity of the surgical debridement covered under CPT code 11044. Therefore, you must include the following:
- Prepare a detailed operative report describing the total surface area of the debrided wound in square centimeters. Provide details of the removed tissues (infected, necrotic, etc.). Also, explicitly mention the bone involvement.
- Document the pre- and post-debridement status, providing details of the wound before and after the procedure.
- Provide specific details of the removed tissue. Simply put, state the type of all removed tissues, e.g., epidermis, dermis, subcutaneous tissue, muscle, fascia, and bone.
- Mention the method of the procedure and details about the surgical instruments.
Summary
With that said, it is time to wrap up this guide. However, before concluding, let’s quickly recap everything that we discussed.
First, we explained the CPT code 11044 descriptor. It covers the surgical removal of dead, infected tissue in the bone, along with the dermis, epidermis, muscle, subcutaneous tissue, and fascia, as required. Besides, you can bill it for the first 20 cm² or less of the debrided surface area.
Next, we shared some real-world clinical scenarios. These include periprosthetic joint infection with exposed necrotic bone, diabetic foot ulcer with osteomyelitis, and localized osteomyelitis due to open fracture.
Moving forward, we looked into all applicable modifiers related to it, including modifier 59 and X{EPSU}. Finally, we discussed the essential billing and reimbursement guidelines for CPT code 11044.
With all these details, billing for the surgical debridement of bone and affected tissue should be easier. However, if you still face challenges, feel free to acquire wound care billing services from professionals at MediBillMD.
