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2025 CPT code 11042

Debridement of subcutaneous tissue (includes epidermis and dermis if performed); first 20 sq cm or less.

Adhere to CPT guidelines for surgical debridement, paying close attention to the surface area and depth of tissue debrided to ensure correct code selection.Modifiers may be required when multiple wounds or procedures are performed on the same day.

Modifiers 25 (E/M service), 59 (distinct procedural service), 77 (repeat procedure by another physician), 78 (unplanned return to OR), and others may be applicable depending on the circumstances. Consult the CPT manual for specific modifier guidance.

Medical necessity for debridement is established by the presence of necrotic, devitalized, or infected tissue that impedes wound healing.The procedure is considered medically necessary to prevent infection, promote healing, and improve the patient's overall health.

The physician is responsible for pre-operative preparation, administration of anesthesia (if needed), surgical debridement using appropriate instruments, hemostasis, application of antibiotics, and wound dressing. Post-operative care is typically included in the global package.

IMPORTANT:For debridement exceeding 20 sq cm, use add-on code 11045 for each additional 20 sq cm. If debridement includes muscle and/or fascia, use code 11043. If debridement involves bone, use code 11044. For debridement of skin only (epidermis and/or dermis), see codes 97597 and 97598.

In simple words: This code represents the surgical removal of dead or infected tissue from just beneath the skin, covering an area no larger than about 3 square inches. The doctor cleans the area, removes the unhealthy tissue using instruments, stops any bleeding, applies medicine, and covers the wound.

CPT code 11042 describes the surgical debridement of subcutaneous tissue, encompassing the epidermis and dermis if involved, up to a maximum area of 20 square centimeters.This procedure involves the removal of necrotic, devitalized, or infected tissue to promote wound healing.The code is applicable to various wound types, including injuries, infections, chronic ulcers, and pressure ulcers.It does not include debridement of bone, muscle, or fascia; separate codes apply for those instances. The procedure includes preparation, anesthesia (if necessary), cleansing, and removal of nonviable tissue until viable bleeding tissue is observed. Hemostasis, antibiotic application, and wound dressing are also part of this procedure.

Example 1: A patient presents with a 15 sq cm diabetic foot ulcer with significant necrotic subcutaneous tissue. The physician performs debridement, removing the devitalized tissue to promote healing., A patient sustains a traumatic leg wound with an area of 18 sq cm of subcutaneous tissue damage requiring surgical debridement.The physician removes the necrotic tissue and prepares the wound for healing., A patient presents with a pressure ulcer on their sacrum measuring 20 sq cm.The physician performs sharp debridement to remove the necrotic tissue, improving the wound bed.

Detailed medical history including the cause and duration of the wound.Precise measurements of the wound dimensions (length, width, depth).Documentation of the type and amount of tissue debrided (e.g., subcutaneous, epidermis, dermis). Photographs of the wound before and after the procedure.Description of the instruments used. Note of the type of dressing applied.Post-operative instructions given to the patient.

** Accurate documentation is critical for proper reimbursement.The code selection should reflect the deepest level of tissue debrided and the total surface area.This code does not encompass non-surgical wound care.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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