12/15/2022

Correct Coding for 4 Ulcer Filings-2 on Each Foot

What is the proper way to file 4 ulcers two on each foot - having a problem with Excellus, of course

The coding is based on the documentation when the ulcer debridement was performed, specifically the total area of all of the wounds on the patient. If the area of all of the wounds is equal to or less than 20 square centimeters, CPT code 11042 should be billed for one unit of service for a subcutaneous ulcer debridement. If a larger area was treated during the visit, CPT code 11045 (the add on code for subcutaneous wound debridement) would be billed for each additional 20 square centimeters.

CPT code 11042 is only billed for one unit of service. Even if the wounds were bilateral, you can only bill one unit of service, regardless of the insurance. Ulcer debridements, regardless, if it is subcutaneous, muscle/fascia, or bone, are billed based on total area, not the number of sites.