2025 CPT code 11043
(Active) Effective Date: N/A Revision Date: N/A Surgery - Debridement Procedures on the Skin Surgery Feed
Debridement of muscle and/or fascia (including epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less.
Modifiers such as 25 (significant, separately identifiable E/M service), 59 (distinct procedural service), and others may be applicable depending on the circumstances of the procedure and other services provided on the same day.Consult the CPT and payer guidelines for the appropriate modifier usage.
Medical necessity is established by the presence of necrotic tissue that impairs wound healing, leading to a significant risk of infection or other complications.Documentation must support the need for surgical debridement rather than less invasive methods.
The physician or qualified healthcare professional performs the debridement procedure, which includes appropriate preparation of the wound and patient, removal of necrotic tissue using surgical instruments, control of bleeding, application of antibiotic, and wound dressing.
In simple words: The doctor surgically removes dead or infected tissue from muscle and/or the tissue surrounding the muscle. This is done for a wound area up to 20 square centimeters to help the wound heal better.
This CPT code describes the surgical procedure of debridement, involving the removal of dead, damaged, or infected tissue from muscle and/or fascia.The procedure may also include debridement of the epidermis, dermis, and subcutaneous tissue if present. This code is applicable for the first 20 square centimeters or less of the total wound surface area. The procedure aims to improve the healing potential of the remaining healthy tissue by removing necrotic material.
Example 1: A patient presents with a 15 sq cm wound on their leg resulting from a dog bite. The wound shows signs of infection and significant necrotic tissue.The physician performs debridement of the muscle and fascia, removing the dead tissue to promote healing and prevent infection. Code 11043 is used., A patient with a diabetic foot ulcer has a 10 sq cm area of necrotic tissue involving the muscle and fascia.The physician performs a debridement to remove the dead tissue, improving blood flow and promoting healing.Code 11043 applies., A patient sustains a traumatic injury resulting in a 20 sq cm wound involving subcutaneous tissue, muscle, and fascia. The physician performs debridement removing all necrotic tissue.Code 11043 is used, along with appropriate modifiers if other procedures were performed on the same day.
Detailed medical record documentation is needed, including the size of the wound, depth of debridement, tissue layers involved (epidermis, dermis, subcutaneous tissue, muscle, fascia), photographs of the wound before and after the procedure, details of any other procedures performed, and the type of dressing applied.
** Always refer to the most current CPT manual and payer guidelines for complete and accurate coding.Remember that accurate documentation is critical for appropriate reimbursement.
- Revenue Code: P5A (AMBULATORY PROCEDURES - SKIN)
- RVU: This information is not available in the provided source.Refer to a current relative value unit database for the most up-to-date information.
- Global Days: The global period information is not provided. This would depend on the specific circumstances and may vary by payer.
- Payment Status: Active
- Modifier TC rule: The provided source does not specify whether a technical component (TC) modifier applies. This would depend on the specific circumstances of the service provision and the payer's guidelines.
- Fee Schedule: Historical fee schedule data is not available in the given source. Refer to a fee schedule database for this information.
- Specialties:General Surgery, Plastic Surgery, Orthopedic Surgery, Wound Care
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient and Outpatient), Urgent Care Facility