Facts to Avoid Confusion During Debridement Billing

Billing Debridement Separately from Surgery

Debridement is a process that involves the removal of foreign material, as well as tissue that is either devitalized or contaminated, until healthy tissue is revealed. Its primary purpose is to clean the affected area and is often performed concurrently with other orthopedic surgical interventions. In my role as an auditor specializing in orthopedics, I frequently encounter situations where healthcare providers submit claims for debridement in addition to extensive surgical procedures. Nevertheless, from a billing perspective, debridement is typically regarded as an integral component of a more comprehensive surgical procedure.

According to the National Correct Coding Initiative (NCCI) Policy Manual, Chapter 4, in its General Policy Statements section, it is stipulated that ‘Debridement of tissue in the surgical field of another musculoskeletal procedure is not separately billable.’

This may seem straightforward at first, but as is often the case with orthopedic coding, there are exceptions that require careful consideration. In this context, there are three specific scenarios in which it is both acceptable and advisable to bill for a debridement procedure separately from a surgical procedure.

  1. Debridement at the Site of an Open Fracture or Dislocation

An open fracture refers to a specific diagnosis, where the bone protrudes through the skin, and it does not denote the type of repair or procedure, such as open reduction. When a debridement is carried out at the site of an open fracture or dislocation, it’s important to reference the CPT® code range 11010-11012, which pertains to debridement, including the removal of foreign material at the location of an open fracture and/or an open dislocation. This procedure should be billed separately in addition to any codes related to the treatment of the fracture.

  1. Arthroscopic Shoulder Debridement

Typically, debridement is considered inclusive when it accompanies various arthroscopic shoulder procedures, even if it is performed in different regions of the shoulder. However, you are eligible to bill for extensive debridement (CPT code 29823) in specific situations. This extensive debridement is defined as the removal of three or more distinct structures, which may include components like humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, or foreign bodies. You can bill 29823 alongside other codes like 29824 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface – Mumford procedure), 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), and/or 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis) even when these procedures are performed in different areas of the shoulder.

It’s important to note that there was a National Correct Coding Initiative (NCCI) edit in effect between October 1, 2022, and December 31, 2022, which bundled 29823 with the procedures mentioned above. However, as of January 1, 2023, this edit has been removed, and you don’t need to append any modifiers apart from the anatomical modifiers for these code combinations.

  1. Arthroscopic Knee Debridement

Generally, you can bill separately for arthroscopic debridement or chondroplasty of the knee when it is performed in a different compartment. However, there is a National Correct Coding Initiative (NCCI) edit that bundles CPT code 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage – chondroplasty) with all other knee scope procedure codes (29866-29889), and this bundling cannot be overridden. Instead, when debridement or the removal of loose bodies is performed in a different compartment, you should consider using HCPCS Level II code G0289 (Arthroscopy, knee, surgical; removal of loose body, foreign body, debridement/shaving of articular cartilage – chondroplasty) when these procedures are performed during the same surgical knee arthroscopy but in a different compartment of the same knee.

However, there is an exception to this exception, which applies to CPT codes 29880 (Arthroscopy, knee, surgical; with meniscectomy, including debridement/shaving of articular cartilage – chondroplasty, same or separate compartment(s)) and 29881 (Arthroscopy, knee, surgical; with meniscectomy, including debridement/shaving of articular cartilage – chondroplasty, same or separate compartment(s)). Since the descriptions of these procedures explicitly mention “chondroplasty in a same OR separate compartment,” you should not report HCPCS code G0289 for debridement/chondroplasty when it is performed alongside a meniscectomy, regardless of whether the procedure is in the same or separate compartment. However, you can still bill HCPCS code G0289 for the removal of loose bodies when a meniscectomy is performed, as long as the loose body is removed from a separate compartment.