Resource Debridement

SuryamolP_67928 · May 23, 2021

Can I get free ceu from here??

Lori · Jun 1, 2022

Codes 11042-11047 describe the work performed during wound excisional debridement.

Key elements to look for in the documentation are:

The technique used (e.g., scrubbing, brushing, washing, trimming, or excisional)
The instruments used (e.g., scissors, scalpel, curette, brushes, pulse lavage, etc.)
The nature of the tissue removed (slough, necrosis, devitalized tissue, non-viable tissue, etc.)
The appearance and size of the wound (e.g., fresh bleeding tissue, viable tissue, etc.)
The depth of the debridement (e.g., skin, fascia, subcutaneous tissue, soft tissue, muscle, bone)

Code choice is determined by the deepest depth of removed tissue & the surface area of the wound

The CPT® codebook directs us to use the Active Wound Care Management codes 97597-97598 for debridement of the skin (i.e., epidermis and dermis only):

Fracture and Dislocation Debridement codes 11010-11012 are based on the depth of the tissue removed, and whether any foreign material was removed at the same time

Update: Reporting of Wound Debridement Procedures Properly

Editor's Note: Updated May 2022, to see the old article, please click here. There are lessons to be learned to avoid damaging coding habits. Wound

icd10monitor.com

Lori · Aug 24, 2023

Medicare payment for wound care services

Correctly coding wound care services in the nursing facility setting is important, given the different ways Medicare pays for such services. Medicare beneficiaries can either be in a Part A covered skilled nursing facility (SNF) stay, which includes medical services as well as room and board, or they can be in a Part B non-covered SNF stay in which Part A benefits are exhausted but certain medical services are still covered, although room and board are not. Under the Balanced Budget Act of 1997, Congress mandated that payment for most services provided to beneficiaries in a Medicare covered Part A SNF stay be included in a bundled prospective payment to the SNF. The SNF is required to bill these bundled services in a consolidated bill to the Part A Medicare administrative contractor. The bundled services cannot be billed separately.

There are a limited number of services specifically excluded from consolidated billing and, therefore, separately payable. Currently, CPT code 17250 is among those excluded from the consolidated billing rule and, therefore, separately reportable. In contrast, CPT codes 97597 and 97598 are subject to the SNF consolidation billing. Reporting 17250 rather than 97597/97598 to avoid consolidated billing would be inappropriate.

These three codes (97602, 97605, 97606) are “bundled” services and not separately payable by Medicare or billable to the patient.

Codes 97597, 97598, and 97602 describe a more extensive service than described by code 17250, as follows:

97597 Debridement (e.g., high-pressure waterjet with or without suction, sharp selective debridement with scissors, scalpel, and forceps), open wound (e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less,

97598 each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure),

97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session.

Active wound care procedures are performed to remove devitalized and/or necrotic tissue and promote healing. For instance, code 97597 involves cleansing the wound thoroughly with copious irrigation, then removing proteinaceous slough, fibrin, and debris covering the wound bed with curette, scalpel, and forceps or scissors until healthy tissue is visualized. Code 97598 involves the same service done over an additional surface area. Chemical cauterization (code 17250) to achieve wound hemostasis is included in these procedures and should not be reported separately for the same lesion.

Active Wound Care Management – CPT codes 97597, 97598, 97602, 97605, 97606, 97607, and 97608

Currently, code 97602 is a status B (bundled) code on the Medicare Fee Schedule for physician’s services (MFSDB); therefore, separate payment is not allowed for this service.
A therapist acting within their scope of practice and licensure performing active wound care management services must add the appropriate therapy modifier (GN, GO, GP) to the CPT code billed. In addition the therapy Revenue Code must be submitted for that service. If a non-therapist performs the service, no therapy modifiers are used and a non-therapy Revenue Code must be submitted for the service. Please see MM10176 for more information.
For debridement codes 97597, 97598, or 97602:
- Debridements should be coded with either selective or non-selective CPT codes (97597, 97598, or 97602) unless the medical record supports a surgical debridement has been performed.
- Dressings applied to the wound are part of the services for CPT codes 97597, 97598 and 97602 and they may not be billed separately.
- It is not appropriate to report CPT code 97602 in addition to CPT code 97597 and/or 97598 for wound care performed on the same wound on the same date of service.
- Code(s) 97597, 97598 and 97602 should not be reported in conjunction with code(s) 11042-11047. The wound depth debrided determines the appropriate code.
  - For example, when only biofilm on the surface of a muscular ulceration is debrided, then codes 97597-97598 would be appropriate. But if muscle substance were debrided, the 11043-11046 series would be appropriate, depending on the area.
Codes 97602, 97605, 97606, 97607 and 97608 include the application of and the removal of any protective or bulk dressings. However, if only a dressing change is performed without any active wound procedure as described by these debridement codes, these debridement codes should not be reported.
Generally, whirlpool is a component of CPT codes 97597/97598 and should not be reported separately during the same encounter. Only when there is a separately identifiable service being treated by the therapist, and the documentation supports this treatment, would the service be considered for payment utilizing modifier 59 or a more specific modifier as appropriate (e.g., LT, RT, XS, etc).

Surgical Debridements – CPT codes 11000-11012 and 11042-11047

Dressings applied to the wound are part of the service for CPT codes 11000-11012 and 11042-11047 and may not be billed separately.
Medicare does not separately reimburse for dressing changes or patient/caregiver training in the care of the wound. It is only appropriate to provide an Advance Beneficiary Notice of Non-coverage (ABN) for services that are anticipated to be denied due to the absence of medical necessity. Based on this information, an ABN for a dressing change is not appropriate since the costs of the dressing change are packaged into other procedures billed.
Debridement of Necrotizing Soft Tissue Infections (CPT codes 11004-11006, and 11008) are inpatient only procedure codes.
The CPT guidelines give direction for reporting single wound debridements (CPT codes 11042-11047) that are at different layers in different parts of the wound, and debridement of wounds at the same and different levels. The depth reported for a single wound is the deepest depth of tissue removed. When debridement at the same depth is performed on two or more wounds, the surface areas of the wounds are combined. When the depth of debridement is not the same, the surface areas are not combined.
- For example, for the debridement codes 11042-11047, when the entire wound surface is debrided, then the measurement of the wound should be taken after the actual debridement procedure is performed. When only a portion of a wound surface is debrided, report the measurement of the area that was actually debrided. If the surface area, depth, and measurement listed in the code descriptor were not performed, then it would not be appropriate to report that code.
CPT codes 11042, 11043, 11044, 11045, 11046, and 11047 are used to report surgical removal (debridement) of devitalized tissue from wounds.
- Use appropriate modifiers when more than one wound is debrided on the same day.
  - Per MLN MM8863, CMS will continue to recognize the -59 modifier, a modifier used to define a “Distinct Procedural Service,” but notes that Current Procedural Terminology (CPT) instructions state that the -59 modifier should not be used when a more descriptive modifier is available. Please see CMS MLN MM8863 for more information.
The use of CPT codes 11042-11047 is not appropriate for the following services: washing bacterial or fungal debris from feet, paring or cutting of corns or calluses, incision and drainage of abscess including paronychia, trimming or debridement of nails, avulsion of nail plates, acne surgery, destruction of warts, or burn debridement. Report these procedures, when they represent covered, reasonable and necessary services using the CPT/HCPCS code that most closely describes the service supplied.
The CPT code selected should reflect the level of debrided tissue (e.g., skin, subcutaneous tissue, muscle and/or bone), not the extent, depth, or grade of the ulcer or wound.
- For example, CPT code 11042 defined as “debridement, subcutaneous tissue” should be used if only necrotic subcutaneous tissue is debrided, even though the ulcer or wound might extend to the bone. In addition, if only fibrin is removed, this code would not be billed.
Debridement of tissue in the surgical field of another musculoskeletal procedure is not separately reportable. However, debridement of tissue at the site of an open fracture or dislocation may be reported separately with CPT codes 11010-11012.
- For example, debridement of muscle and/or bone (CPT codes 11043-11044, 11046-11047) associated with excision of a tumor of bone is not separately reportable. Similarly, debridement of tissue (e.g., CPT codes 11042, 11045, 11720-11721, 97597, 97598) superficial to, but in the surgical field, of a musculoskeletal procedure is not separately reportable.
The debridement code submitted should reflect the type and amount of tissue removed during the procedure as well as the depth, size, or other characteristics of the wound. Submitting documentation substantiating depth of debridement when billing the debridement procedure described by CPT code 11044 is encouraged.
- For example, if a wound involves exposed bone but the debridement procedure did not remove bone, CPT code 11044 cannot be billed.

Lori · Aug 24, 2023

Use of Evaluation and Management (E/M) Codes in Conjunction with Surgical Debridements

E/M codes are not usually billed in conjunction with a debridement procedure. When providing and billing surgical debridement, the surgical debridement service is to include: the pre-debridement wound assessment, the debridement, and the post-procedure instructions provided to the patient on the date of the service. When a "reasonable and necessary" E/M service is provided and documented on the same day as a debridement service, it is payable by Medicare when the documentation clearly establishes the service as a "separately identifiable service" that was reasonable and necessary, as well as distinct, from the debridement service(s) provided.

Low frequency, non-contact, non-thermal ultrasound (MIST Therapy) – CPT code 97610

One 97610 service per day is allowable for a qualifying wound. CPT Code 97610 is not separately reportable for treatment of the same wound on the same day as other active wound care management CPT codes (97597-97606) or wound debridement CPT codes (e.g., CPT codes 11042-11047, 97597, 97598).

Debridement and Unna boot

All supply items related to the Unna boot are inclusive in the reimbursement for CPT code 29580. When both a debridement is performed and an Unna boot is applied, only the debridement may be reimbursed. If only an Unna boot is applied and the wound is not debrided, then only the Unna boot application may be eligible for reimbursement. The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services Chapter 4, section G states that debridement codes (11042-11047, 97597) should not be reported with codes 29580, 29581 for the same anatomic area.

Debridement including removal of foreign material at the site of an open fracture or open dislocation may be reported with CPT codes 11010-11012. Since these codes would be reported with a CPT code for treatment of the open fracture or dislocation, a casting/splinting/strapping code should not be reported separately.

Medical Necessity

All Providers (including therapists) must document the medical necessity for all services provided. If there is no documented evidence (e.g., objective measurements) of ongoing significant benefit, then the medical record documentation must provide other clear evidence of medical necessity for treatments. The medical record must also clearly indicate the complexity of skills required by the treating practitioner/clinician.

Coding

Proper wound care coding requires careful reading of all Current Procedural Terminology (CPT) code descriptors and related CPT Manual instructions. Providers should note that some codes are per session or per wound surface area, not per wound or site.

Evaluation and Management (E/M) Coding Requirements

• Only physicians and NPPs (Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Physician Assistants (PAs) can provide and bill E/M and CPT 11000 series codes when the services are appropriate and state licensure allows. These services may not be provided as incident-to services by hospital staff.
• Services provided by qualified incident-to hospital staff, must meet both the incident-to service delivery requirements and the CPT descriptor requirements for the specific procedure.

*Note: For claims with dates of service prior to January 1, 2014: Hospitals may bill any E/M level within the "established patient" category that corresponds to the resources used in the provision of the covered 99211 service in the specific clinic. The charge must be the same for all patients. See the CMS manuals for additional billing instructions. Reference the Noridian article titled "Incident To" Clarification for OPPS and CAH Outpatient attached below for additional information.

For claims with dates of service on or after January 1, 2014: Hospitals may only bill HCPCS G0463. The charge must be the same for all patients. See the CMS manuals for additional billing instructions. Reference the Noridian article titled "Incident to" Clarification for OPPS and CAH Outpatient attached below for additional information.

Physical Medicine and Rehabilitation (PM&R) Codes (i.e. 97597, 97598, 97602)

• A physician, NPP or therapist acting within their scope of practice and licensure may provide debridement services and use the PM&R codes including CPT 97597, 97598 and 97602.
• These codes must only be billed for services that include medically necessary skilled debridement services.
• Hospital staff acting within their scope of practice and/or licensure may provide wound care, including debridement services, incident-to the services of a physician/NPP.
• Staff providing therapy services incident-to the physician treatment plan must meet the qualification guidelines established for auxiliary personnel as described in the IOM Medicare Benefit Policy Manual, Publication 100-02, Chapter 15, Sections 220(A), 230.5.
•CPT 97597, 97598, 97602 are considered “sometimes therapy” codes according to the IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 5, Section 20. As such, these treatment codes may be provided without a therapy plan of care by physician/NPPs or as incident-to services. When these “sometimes therapy” services are provided under a physician's/NPPs treatment plan they should be billed without a therapy modifier.
• When wound care services are delivered by therapists, there must be a physician certified therapy plan of care based on a thorough evaluation signed by the treating physician or NPP. The services must be billed using the appropriate therapy modifier and deliver within the CMS therapy guidelines found in the IOM Medicare Benefit Policy Manual, Publication 100-02, Chapter 15, Sections 100 and 220-230.

Dressing Change

A dressing change may not be billed as either a debridement or other wound care service under any circumstance (e.g., CPT 97597, 97598, 97602).

• Medicare does not separately reimburse for dressing changes or patient/caregiver training in the care of the wound. These services are reimbursed as part of a billable E/M or procedure code that, commonly but not necessarily, occurs on the same date of service as the dressing change. If not included in another service, the costs associated with dressing changes may be reported as not separately payable.
• All topical applications (e.g. medications, ointments, and dressings) are included in the payment for the procedure codes.
• It is only appropriate to provide an Advance Beneficiary Notice of Noncoverage (ABN) for services that are anticipated to be denied due to the absence of medical necessity. An ABN for a dressing change is NOT appropriate since the costs of the dressing change are packaged into other procedures billed.

Evaluation/Re-assessment

In general, other than an initial evaluation, the assessment of the wound is an integral part of all wound care service codes and, as such, these assessments are not separately billable.

• Initial wound assessments that are medically necessary may be reimbursable as a separately identifiable Evaluation and Management (E/M) service or i.e., physical therapy initial evaluation CPT codes 97161-97163. Note that CPT codes 97160-97163 are "always" therapy codes and the therapy modifier must be applied.
• Re-assessment/re-evaluation of a wound (which may be completed with a dressing change) is generally considered to be a non-covered routine service. An exception would require documentation clearly supporting that there had been a significant improvement, decline, or change in the patient’s condition or functional status that was not anticipated in the plan of care and required further evaluation.
• The evaluation must be provided by a physician, NPP or therapist or other qualified incident-to hospital staff.
• Patients may be evaluated by the physician/NPP and the follow-up care may then be provided by qualified hospital incident-to staff working under the physician’s plan of care. When a physical therapist provides these incident-to follow-up services and provides an initial therapy evaluation (CPT 97161-97163), the documentation must clearly indicate the medical necessity for these additional evaluative services (as compared to the previously completed physician evaluation of the patient’s condition) in order to be separately reimbursable.
• An ABN may be given when medical necessity is not supported for the initial therapy evaluation. However, an ABN may not be given when medical necessity is not supported for a follow-up visit since there is no billable therapy code for a routine re-assessment (i.e. routine wound assessment with/without a dressing change).
• While a physician/NPP may not bill a new patient E/M with modifier 25 for any global service, the hospital may bill the E/M. See the IOM Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 40.3.

Lori · Aug 24, 2023

The provider removes dead tissue from a wound without differentiating between viable and nonviable tissues. This service helps in assessing the depth of the wound, reduces the risk of infection and speeds the healing process. The service also aides in providing proper wound care instructions to the patient. The code is reported per debridement session.

Description of the wound, including size (length x width); depth; total sq cm; appearance; drainage; undermining; peri-wound character; presence of edema, infection, and disease causing underlying problems or complication(s) for the wound healing process.
Description of the method of debridement (scalpel, nippers, scissors, curette), and which deepest layer of tissue was removed or debrided (fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm; subcutaneous tissue; muscle and/or bone).
Clear description of the tissue being cut away in the chart notes.
Specification of which dressings were applied, post-op care instructions provided, progress of the wound, and on follow-up visit notes, future plans.
Description of wound improvement or measurable changes (e.g., decrease in drainage, inflammation, necrotic tissue or slough, pain, swelling, wound dimension changes, or declining improvement). Steps done to address the new condition might include oral antibiotics, further testing, biopsy of the wound, consultations requested for vascular intervention, or podiatric consultation for bracing or off-loading.
Debridements should be classified as selective or non-selected CPT codes (97597, 97598, or 97602) unless the medical record indicates that a surgical debridement was done.
Dressings applied to wounds are included in the services provided by CPT codes 97597, 97598, and 97602 and may not be invoiced separately.
CPT code 97602 should not be reported in addition to CPT codes 97597 or 97598 for wound treatment done on the same wound on the same date of service.
Codes 97597, 97598, and 97602 should not be submitted with codes 11042-11047. The proper code is determined by the wound depth debrided.
Codes 97597-97598 are suitable when only the bacteria on the surface of a muscle ulceration is debrided. However, depending on the location, the 11043-11046 series would be appropriate for debriding muscle material.
97602, 97605, 97606, 97607, and 97608 cover the application and removal of any protective or bulk dressings. These debridement codes should not be recorded if a dressing change is conducted without any active wound procedure defined by these debridement codes.
Whirlpools are generally included in CPT codes 97597/97598 and should not be recorded separately during the same interaction.

Debridement

Selective Debridement (CPTs 97597 and 97598) - Documentation to support selective debridement should include the following:

• Clear description of instruments used for debridement (i.e. high-pressure waterjet, scissors, scalpel, forceps).
• Thorough objective assessment of the wound including drainage, color, texture, temperature, vascularity, condition of surrounding tissue, and size of the area to be targeted for debridement

Non-Selective Debridement (CPT 97602) - Documentation to support non-selective debridement should include:
• Type of technique utilized i.e., wet-to-moist, enzymatic, abrasion.
• Thorough objective assessment of the wound as described in Selective Debridement above.

Whirlpool

• If the patient uses whirlpool for treatment of a wound prior to receiving selective debridement services for the wound during the same visit, then the whirlpool is not separately reimbursable and should not be billed with modifier 59 unless two separate wounds are treated with the different modalities.
• If the patient uses whirlpool for treatment of a wound prior to receiving non-selective debridement services for the wound during the same visit, then the whirlpool is separately reimbursable and may be billed with modifier 59.
• Whirlpool can also be completed during the same visit for non-wound care related purposes. It is appropriate to separately bill CPT 97022 when the whirlpool is used for other purposes not involving wound care i.e., facilitation of range of motion activities

Unna Boot Application

All supply items related to the Unna boot are inclusive in the reimbursement for CPT 29580.

High Compression Multi-Layered Bandage Systems

The application of the high compression bandage systems (i.e., Profore, Dyna-Flex, Surepress, Setopress, and other similar product systems) are used to primarily treat lymphedema and venous or stasis ulcers. Providers should note that the treatment of lymphedema with the application of high compression bandage systems continues to be non-covered by Medicare. However, a brief period of patient and/or caregiver education may be medically necessary and reimbursable. Noridian will cover and separately reimburse for the application training when Medicare coverage requirements are met. Further information may be found in the Noridian article titled High Compression Bandage System Clarification.

Lori · Aug 24, 2023

Maggot therapy

Maggots' ability to prevent infections and promote wound healing has been known since the 19th century. Increasing problems with treatment-resistant wounds and antibiotic-resistant bacteria has aroused interest in maggot therapy.

Is an old remedy, which is being looked into with renewed interest. The use of medicinal maggots was approved by the Food and Drug Administration (FDA) as a medical device in 2004. Maggot therapy appears to be efficacious, well-tolerated, and cost-effective. Because the American Medical Association (AMA) and Centers for Medicare and Medicaid (CMS) released reimbursement coding guidelines with regard to maggot therapy, there is a potential for a wider use of maggot therapy in the United States in the near future. Several mechanisms of action suggested for maggots in debriding wounds are discussed. While maggot therapy demonstrated effectiveness in necrotic wounds, not all wound types respond well to maggot therapy. Future large, randomized, well-designed studies would help better delineate the place of maggot therapy among other options for wound care, and determine whether maggot therapy should be initiated earlier in the course of treatment, or continued to be used as a last resort.

Maggot therapy is the medical use of disinfected fly larvae (usually the larvae of Lucilia sericata) in the treatment of wounds resistant to conventional treatment. The maggots work through three mechanisms of action; they debride wounds by dissolving necrotic tissue, clean wounds by killing bacteria, and promote wound healing. The larvae have a broad antibacterial action against Gram-negative and Gram-positive bacteria, including MRSA. Maggot therapy is used to debride a number of complicated skin and soft tissue wounds - e.g... pressure ulcers, venous stasis ulcers, neurovascular ulcers, traumatic wounds, and burns - but also as a treatment for osteomyelitis. Large controlled clinical trials have not been performed. Maggot therapy has not been associated with serious side effects.

The larvae of Lucillia sericata, or maggots of the green-bottle fly, are used worldwide to help debride chronic, necrotic, and infected wounds. Whilst there is abundant clinical and scientific evidence to support the role of maggots for debriding and disinfecting wounds, not so much emphasis has been placed on their role in stimulating wound healing. However, there is accumulating evidence to suggest that maggots and their externalized secretions may also promote wound healing in stubborn, recalcitrant chronic ulcers. There are a growing number of clinical reports that support the observation that wounds that have been exposed to a course of maggot debridement therapy also show earlier healing and closure end-points. In addition, recent pre-clinical laboratory studies also indicate that maggot secretions can promote important cellular processes which explains this increased healing activity. Such processes include activation of fibroblast migration, angiogenesis (the formation of new blood vessels from pre-existing vessels) within the wound bed, and enhanced production of growth factors within the wound environment. Thus, in this review, we summarize the clinical evidence that links maggots and improved wound healing, and we précis recent scientific studies that examine and identify the role of maggots, particularly individual components of maggot secretions, on specific cellular aspects of wound healing.

Medical maggots received 510(k) marketing clearance by the FDA and are intended to debride non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers, and non-healing traumatic or post-surgical wounds. According to information submitted by the manufacturer to the FDA, the fly eggs are chemically disinfected before being placed in sterile vials for transport. The dressings used to confine them on the wound are called "Creature Comforts" and are designed to create a confining "cage dressing." They are applied directly to the wound surface in a dose of 5 to 8 maggots per square cm. The dressings are left in place on the wound for a "cycle" of 48 hours (24 to 72 hours); 1 to 3 cycles are applied weekly. Most wounds require 2 to 6 cycles for complete debridement.

Medical Necessity

Medical maggots for the debridement of any of the following non-healing necrotic skin and soft tissue wounds:
Chronic diabetic foot ulcers; or
Neuropathic foot ulcers; or
Non-healing traumatic or post surgical-wounds; or
Pressure ulcers; or
Venous stasis ulcers.

CPT Codes / HCPCS Codes / ICD-10 Codes

Code	Code Description
*Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+"*:
There is no specific CPT code for medicinal leech therapy:
Other CPT codes related to the CPB:
30400 -hyphen 30462	Rhinoplasty
ICD-10 codes covered if selection criteria are met:
I87.1	Compression of vein
I87.2	Venous insufficiency (chronic) (peripheral)
I99.8	Other disorder of circulatory system
T86.820 -hyphen T86.829	Complications of skin graft (allograft) (autograft)
T87.0x1 -hyphen T87.2	Complications of reattached extremity or body part
Z89.011 -hyphen Z89.9	Acquired absence of limb
ICD-10 codes not covered for indications listed in the CPB:
B20	Human immunodeficiency virus [HIV] disease
D80.0 -hyphen D89.9	Certain disorders involving the immune mechanism
G89.3	Neoplasm related pain (acute) (chronic)
G90.50 -hyphen G90.59	Complex regional pain syndrome I (CRPSI)
K64.0 -hyphen K64.4 K64.8 -hyphen K64.9	Hemorrhoids
L72.0	Epidermal cyst
M00.00 -hyphen M99.9	Diseases of the musculoskeletal system and connective tissue
N48.30 -hyphen N48.39	Priapism
Z21	Asymptomatic human immunodeficiency virus [HIV] infection status
*Medical maggots/Bagged larval therapy*:
CPT codes covered if selection criteria are met:
97602	Removal of devitalized tissue from wound(s), non-hyphenselective debridement, without anesthesia (eg, wet-hyphento-hyphenmoist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session
ICD-10 codes covered if selection criteria are met:
E08.610 -hyphen E08.69	Diabetes mellitus due to underlying condition with other specified complications
E09.610 -hyphen E09.69	Drug or chemical induced diabetes mellitus with other specified complications
E10.621	Type 1 diabetes mellitus with foot ulcer
E11.621	Type 2 diabetes mellitus with foot ulcer
E13.621	Other specified diabetes mellitus with foot ulcer
I83.001 -hyphen I83.029	Varicose veins of lower extremities with ulcer
I83.201 -hyphen I83.229	Varicose veins of lower extremities with ulcer and inflammation
L89.000 -hyphen L89.95	Pressure ulcer
L97.101 -hyphen L97.929	Non-hyphenpressure chronic ulcer of lower limb, not elsewhere classified
L98.411 -hyphen L98.499	Non-hyphenpressure chronic ulcer of skin, not elsewhere classified
T81.89x+	Other complications of procedures, not elsewhere classified [non-hyphenhealing surgical wound]
Numerous options	Open wounds, complicated [non-hyphenhealing] [Codes not listed due to expanded specificity]
ICD-10 codes not covered for indications listed in the CPB
B35.0 -hyphen B49	Mycoses
E10.610 -hyphen E10.620, E10.622 -hyphen E10.69	Type 1 diabetes mellitus with other specified complications
E11.610 -hyphen E11.620, E11.622 -hyphen E11.69	Type 2 diabetes mellitus with other specified complications
E13.610 -hyphen E13.620, E13.622 -hyphen E13.69	Other specified diabetes mellitus with other specified complications
S61.401 -hyphen S61.459	Open wound of hand [not covered for mycotic infections]
T20.00xA -hyphen T32.99	Burns and corrosions

Bio-Surgery: Medicinal Leech Therapy and Medical Maggots - Medical Clinical Policy Bulletins | Aetna

www.aetna.com

Lori · Aug 24, 2023

Bagged larval therapy is considered an equally effective alternative to medical maggot therapy.

Some providers consider bagged larval therapy/medical maggots experimental and investigational for all other indications (e.g., burn wounds and hand injury complicated by mycotic infection) because of insufficient evidence of its safety and effectiveness.

The medicinal leech, Hirudo medicinalis, has been used increasingly for relief of venous congestion, especially for salvage of compromised pedicled flaps and microvascular free-tissue transfer, digital re-implantation, and breast reconstruction. Leech therapy for compromised flaps is best used early since flaps demonstrate significantly decreased survival after 3 hours if venous congestion is not relieved. If venous pooling occurs around a flap or replant, the skin becomes cyanotic, cool, and hard. If capillary refill time (CRT) remains more than 3 seconds the flap or replant will not survive. The objective of leech therapy is for the affected area to become pink and warm, with a CRT of less than 2 seconds.

When leeches begin feeding, they inject salivary components (e.g., hirudin) that inhibit both platelet aggregation and the coagulation cascade. This results in a marked relief of venous congestion. The anti-coagulant causes the bite to ooze for up to 48 hours following detachment, further relieving venous congestion. By feeding for 10 to 60 mins, leeches consume from 1 to 2 teaspoons of blood. Results from clinical studies showed that the success rate of salvaging tissue with medicinal leech therapy is 70 to 80 %. On June 28, 2004, the Food and Drug Administration (FDA) had for the first time cleared the commercial marketing of leeches for medicinal purposes (in skin grafts and re-attachment surgery).

Can be useful in treating:

Cancer pain
Complex regional pain syndrome (i.e., CRPS-I, CRPS-II)
Epicondylitis
Epidermoid cysts (also called epidermal cysts or epidermal inclusion cysts)
Hematomas
Hemorrhoids
Knee osteoarthritis
Inadequate arterial supply or tissue ischemia
Low back pain
Priapism
Rheumatoid arthritis and other musculoskeletal diseases
Thumb osteoarthritis
Use after rhinoplasty.

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Resource Debridement

SuryamolP_67928

New member

Lori

Well-known member

Update: Reporting of Wound Debridement Procedures Properly

Lori

Well-known member

Medicare payment for wound care services

Lori

Well-known member

Lori

Well-known member

Lori

Well-known member

Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":

There is no specific CPT code for medicinal leech therapy:

Other CPT codes related to the CPB:

ICD-10 codes covered if selection criteria are met:

ICD-10 codes not covered for indications listed in the CPB:

Medical maggots/Bagged larval therapy:

CPT codes covered if selection criteria are met:

ICD-10 codes covered if selection criteria are met:

ICD-10 codes not covered for indications listed in the CPB

Bio-Surgery: Medicinal Leech Therapy and Medical Maggots - Medical Clinical Policy Bulletins | Aetna

Lori

Well-known member

Register to Access the Free Forums and 3 Free CEUs!

Resource Debridement

New member

Well-known member

Well-known member

Medicare payment for wound care services​

Well-known member

Well-known member

Well-known member

Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":​

There is no specific CPT code for medicinal leech therapy:​

Other CPT codes related to the CPB:​

ICD-10 codes covered if selection criteria are met:​

ICD-10 codes not covered for indications listed in the CPB:​

Medical maggots/Bagged larval therapy:​

CPT codes covered if selection criteria are met:​

ICD-10 codes covered if selection criteria are met:​

ICD-10 codes not covered for indications listed in the CPB ​

Well-known member

Medicare payment for wound care services

Information in the [brackets] below has been added for clarification purposes. Codes requiring a 7th character are represented by "+":

There is no specific CPT code for medicinal leech therapy:

Other CPT codes related to the CPB:

ICD-10 codes covered if selection criteria are met:

ICD-10 codes not covered for indications listed in the CPB:

Medical maggots/Bagged larval therapy:

CPT codes covered if selection criteria are met:

ICD-10 codes covered if selection criteria are met:

ICD-10 codes not covered for indications listed in the CPB