Contractor Name ^{back to top}

National Government Services, Inc.  

Contractor Number ^{back to top}

00308 

Contractor Type ^{back to top}

FI 

LCD ID Number ^{back to top}

L637 

LCD Title ^{back to top}

Debridement Services 

Contractor's Determination Number ^{back to top}

AMA CPT / ADA CDT Copyright Statement ^{back to top}

CPT codes, descriptions and other data only are copyright 2007 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 National Coverage Policy ^{back to top}

1. Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

2. Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services considered medically reasonable and necessary.

3. Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim. 

Primary Geographic Jurisdiction ^{back to top}

Connecticut
Delaware
New York - Entire State
 

Secondary Geographic Jurisdiction ^{back to top}

Oversight Region ^{back to top}

Region II
 

Original Determination Effective Date ^{back to top}

For services performed on or after 08/01/2001  

Original Determination Ending Date ^{back to top}

Revision Effective Date ^{back to top}

For services performed on or after 03/01/2008  

Revision Ending Date ^{back to top}

Indications and Limitations of Coverage and/or Medical Necessity ^{back to top}

Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound. The codes in this policy cover debridement of skin, subcutaneous tissue, fascia, muscle, bone and removal of foreign material. Debridement promotes wound healing by reducing sources of infection and other mechanical impediments to healing. Its goal is to cleanse the wound, reduce bacterial contamination and provide an optimal environment for wound healing or possible surgical intervention. The usual end point of debridement is removal of pathological tissue and/or foreign material until healthy tissue is exposed. Debridement techniques include, among others, sharp and blunt dissection, curettement, scrubbing, and forceful irrigation. Surgical instruments may include a scrub brush, irrigation device, electrocautery, laser, sharp curette, forceps, scissors, burr or scalpel. Prior to debridement, determination of the extent of an ulcer/wound may be aided by the use of blunt probes to determine wound/ulcer depth and to disclose abscess and sinus tracts.

This local coverage determination (LCD) does not apply to debridement of burned surfaces. For debridement of burned surfaces CPT codes 16000-16036 apply. Regulations concerning the use of these codes are not addressed in this LCD.

Indications:
1. Debridement is indicated for any wound requiring removal of deep seated foreign material, devitalized or nonviable tissue at the level of skin, subcutaneous tissue, fascia, muscle or bone, to promote optimal wound healing or to prepare the site of appropriate surgical intervention.

2. The CPT code selected should report the level of debrided tissue, (e.g., partial thickness skin, full thickness skin, subcutaneous, muscle, bone), not the extent, depth, or grade of the ulcer or wound. For example, use CPT code 11042 if an ulcer extends to bone (grade 4) but only necrotic skin and subcutaneous tissue are debrided.

3. CPT codes 11000 and 11001 describe removal of extensive eczematous or infected skin. A key word is extensive. 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), or autoimmune skin diseases (such as pemphigus).

4. CPT codes 11010 - 11044 should be used for debridement of relatively localized areas depending upon the involvement of contiguous underlying structures. These codes are appropriate for treatment of skin ulcers, circumscribed dermal infections, conditions affecting contiguous deeper structures, and debridement of deep-seated debris from any number of injury types.

5. The number of debridement services required is variable and depends on numerous intrinsic and extrinsic factors. Among these are the duration, size and depth of the wound and the amount of fibrotic or necrotic tissue present. Treatment duration varies with clinical response but may also be
affected by any of the following parameters: mental status, mobility, infection, tissue oxygenation, chronic pressure, arterial insufficiency/small vessel ischemia, venous stasis, edema, type of dressing, chronic illness such as diabetes mellitus, uremia, COPD, malnutrition, CHF, anemia, iron deficiency, and immune deficiency disorders. Debridement services are covered provided all significant relevant comorbid conditions are addressed that could interfere with optimal wound healing.

6. Debridement for osteomyelitis is covered for chronic osteomyelitis and osteomyelitis associated with an open wound. The use of debridement in diagnosed hematogenous osteomyelitis is covered with documented failure of a four (4) to six (6) week course of antibiotic therapy.

Limitations:
1. If there is no necrotic, devitalized, fibrotic, or other tissue or foreign matter present that would interfere with wound healing, debridement is not medically necessary. The presence or absence of such tissue or foreign matter must be documented in the medical record.

2. The following procedures are considered part of an evaluation and management (E&M) service, and are not generally separately covered: removal of necrotic tissue by cleansing and dressing, including wet-to-dry dressing changes; cleaning and dressing small or superficial lesions; removal of coagulated serum from normal skin surrounding an ulcer; scraping and trimming of calluses and corns.

3. CPT codes 11000 and 11001 are not appropriate debridement of a localized amount of tissue normally associated with a circumscribed lesion. Examples of this are ulcers, furuncles, localized skin infections, soft corns in the toe web or peeling skin on the soles of the feet from superficial fungal infections, i.e. (tinea pedis/athlete's foot.)

4. CPT code 11001 is limited to those practitioners who are licensed to perform surgery above the ankle, since the amount of skin required by the code is more than that contained on both feet.

5. 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 generally does not require debridement that would be considered necessary and reasonable. These lesions typically heal without significant surgical intervention beyond removal of the corn and shoe modification.

6. Cornerstones of chronic foot ulcer management include relief of pressure, control of infection and appropriate debridement. While there is some consensus that frequent repeated debridement may promote more rapid healing of diabetic foot ulcers, the appropriate interval and frequency depends on the individual clinical characteristics of patients and ulcers. Reduction of pressure and/or control of infection reduce the need for repeated frequent debridement. The treatment plan for a patient who requires frequent repeated debridement should be reconsidered, to ensure that pressure reduction and infection control have been adequately addressed. Debridement is not considered reasonable and necessary if pressure reduction and infection control are insufficient to allow for healing of the ulcer.

7. Procedures performed for cosmetic reasons or to prepare tissues for cosmetic procedures are statutorily excluded from coverage by Medicare.

8. Use of CPT codes 11000 - 11044 is not appropriate for the following services: washing bacterial or fungal debris from feet, paring or cutting of corns or calluses, incision and drainage of abscess including paronychia, trimming or debridement of nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Report these procedures, when they represent covered, reasonable and necessary services, using the CPT or HCPCS code that most closely describes the service supplied.

9. Removing a collar of callus (hyperkeratotic tissue) around an ulcer is not debridement of skin or necrotic tissue and should not be billed as debridement. 

Coverage Topic ^{back to top}

Surgical Services
 

Bill Type Codes: ^{back to top}

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Revenue Codes: ^{back to top}

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

CPT/HCPCS Codes ^{back to top}

ICD-9 Codes that Support Medical Necessity ^{back to top}