Association for the Advancement of Wound Care

Association for the Advancement of Wound Care Alert Debridement Codes APLIGRAF® & DERMAGRAFT® 2011

CMS has released the Final Proposed Rule for the Physician Fee Schedule for CY 2011……..

Application of Tissue Cultured Skin Substitutes to Lower Extremities (HCPCS Codes
G0440 and G0441)

New G codes for payment under the PFS for the application of Apligraf or Dermagraft to the lower limb under the PFS in CY 2011.

These codes would not allow separate reporting for site preparation or debridement or the use of -58 modifier.

  • HCPCS G0440 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less)
  • HCPCS code G0441 (Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; each additional 25 sq cm)

Excision and Debridement
(CPT codes 11010, 11011, 11012, 11042, 11043, 10144, 11045, 11046, 11047, and 97598)

  • 11042 (Debridement subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square centimeters or less). 0.80 work RVU
  • 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 square centimeters or less) 2.00 work RVU
  • 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 square centimeters or less) 3.60 work RVU
  • 11045 (Debridement subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 square centimeters 0.33 work RVU
  • 11046 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 square centimeters
    0.70 work RVU
  • 11047 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 square centimeters, or part thereof) 1.20 work RVU

For CY 2011, the services previously reported by CPT codes 11040 (Debridement; skin, partial thickness) and 11041 (Debridement; skin, full thickness) will now be reported with revised codes:

  • 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 square centimeters 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 square centimeters, or part thereof (List separately in addition to code for primary procedure)).