**Abstract:**  
  
Debridement is the removal of infected, contaminated, damaged, devitalized,
necrotic, or foreign tissue from a wound. The codes in this local coverage
determination (LCD) 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 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. This LCD does not apply to
debridement of nails and the provider is referred to CGS LCD Routine Foot Care
and Debridement of Nails (L34246). This LCD does not apply to debridement
services performed by physical or occupational therapists. For debridement
services performed by physical or occupational therapists, please use CPT
codes 97597, 97598 and 97602. Providers should refer to CGS LCD for Outpatient
Physical and Occupational Services (L34049).  
  
 **Indications:**  
  
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.  
  
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).  
  
CPT codes 11040 and 11041 have been deleted and providers (including
physicians and non-physician practitioners) are instructed to use CPT codes
97597 and 97598 for selective debridement of non-viable tissue in
wounds/ulcers. These CPT codes are contained in CGS LCD for Outpatient
Physical Therapy and Occupational Services (L34049). Please refer to that LCD
for additional information on use of these CPT codes and services.  
  
CPT codes 11042-11047 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.  
  
The number of debridement services required is variable and depends on
numerous intrinsic and extrinsic factors. Debridement services are covered
provided all significant relevant comorbid conditions are addressed that could
interfere with optimal wound healing.  
  
Debridements of the wound(s) if indicated must be performed judiciously and at
appropriate intervals. It is expected that, with appropriate care, and no
extenuating medical or surgical complications or setbacks, wound volume or
surface dimension should decrease over time. It is also expected the wound
care treatment plan is modified in the event that appropriate healing is not
achieved. It is expected that co-morbid conditions that may interfere with
normal wound healing have been addressed; the etiology of the wound has been
determined and addressed as well as addressing patient compliance issues. This
may include, for example, evaluation of pulses, ABI and/or possible
consultation with a vascular surgeon.  
  
 **Limitations:**  
  
If there is no necrotic, devitalized, fibrotic, or other tissue or foreign
matter present that would interfere with wound healing, the debridement
service is not medically necessary. The presence or absence of such tissue or
foreign matter must be documented in the medical record.  
  
The following procedures are considered part of active wound care management,
and are not considered as debridement and are not included in this LCD:
Removal of devitalized tissue from wound(s), non - selective debridement,
without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion),
including topical application(s), wound assessment, and instruction(s) for
ongoing care.  
  
CPT codes 11000 and 11001 are not appropriate for debridement of a localized
amount of tissue normally associated with a circumscribed lesion. Examples of
this are ulcers, furuncles, and localized skin infections.  
  
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.  
  
Skin breakdown under a dorsal corn is not considered an ulcer and generally
does not require debridement. These lesions typically heal without significant
surgical intervention beyond removal of the corn and shoe modification.  
  
Removing a collar of callus (hyperkeratotic tissue) around an ulcer is not
debridement of skin or necrotic tissue and should not be billed as such. The
service should be billed under CPT code 11055 or 11056. Please refer to CGS
LCD Routine Foot Care and Debridement of Nails (L34246) for information
regarding these CPT codes. This LCD does not apply to debridement services
performed by physical or occupational therapists. For debridement services
performed by physical or occupational therapists, please use CPT codes 97597,
97598 and 97602. Providers should refer to CGS LCD for Outpatient Physical and
Occupational Services (L34049).  
  
Debridement for osteomyelitis is covered for chronic osteomyelitis and
osteomyelitis associated with an open wound.  
  
Local infiltration, metacarpal/digital block or topical anesthesia are
included in the reimbursement for debridement services and are not separately
payable. Anesthesia administered by or incident to the provider performing the
debridement procedure is not separately payable.  
  
 **Other Comments:**  
  
For claims submitted to the Part A MAC: this coverage determination also
applies within states outside the primary geographic jurisdiction with
facilities that have nominated CGS Administrators, LLC. to process their
claims.  
  
Bill type codes only apply to providers who bill these services to the Part A
MAC. Bill type codes do not apply to physicians, other professionals and
suppliers who bill these services to the carrier or Part B MAC.  
  
For dates of service on or after April 1, 2010, bill type 77X should be used
to report FQHC services.  
  
Limitation of liability and refund requirements apply when denials are
anticipated, whether based on medical necessity or other coverage reasons. The
provider/supplier must notify the beneficiary in writing, prior to rendering
the service, if the provider/supplier is aware that the test, item or
procedure may not be covered by Medicare. The limitation of liability and
refund requirements do not apply when the test, item or procedure is
statutorily excluded, has no Medicare benefit category or is rendered for
screening purposes.