Download Revised Debridement Codes AMA 11043-11044-Svy

The AMA / RUC Physician Work Survey
Changes to the debridement CPT codes 11040-11044 have been approved for CPT 2011.
Brief Summary:
CPT 11040 and 10041 will be deleted, with referral to Active Wound Care codes 97597-97598.
CPT 11042, 10043, and 11044 will be split into two codes – first 20 sq cm and each add'l 20 sq cm.
CPT 11042 global period will remain 0-days.
CPT 11043 and 11044 global period will be changed from 10-days to 0-days.
New codes 1140X5, 1104X6, and 1104X7 (each add'l 20 sq cm) will have a ZZZ-global (add-on).
These code additions, deletions, and revisions require review of physician work. The American College of
Surgeons and the AMA/Specialty Society RVS Update Committee (RUC) need your help to assure relative values
will be accurately and fairly presented to the Centers for Medicare and Medicaid Services (CMS) during this review
process. This is important to you and other physicians because these values determine the rate at which Medicare
and other payers reimburse for procedures
START HERE
Please Complete Survey Areas Shaded in Green
Physician's NAME Last:
First:
Physician’s Primary Office (STATE)
E-mail address
General surgeon
Orthopaedic surgeon
SPECIALTY
(check all that apply)
Plastic surgeon
Vascular surgeon
Podiatrist
Other (specify) 
YEARS Practicing Specialty
Rural
Primary Geographic Practice Setting:
(check one)
Suburban
Urban
Solo Practice
Primary Type of Practice:
(check one)
Single Specialty Group
Multispecialty Group
Medical School Faculty Practice Plan
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
CPT 2011 Additions, Deletions, and Revisions
Surgery / Integumentary System
Skin, Subcutaneous and Accessory Structures
Debridement
Wound debridements (11042-11047X) are reported by depth of tissue that is removed and by surface area of the
wound. These services may be reported for injuries, infections, wounds and chronic ulcers. These services are
reported when the intent is not to perform a primary closure (see 15002-15005), except when debridement is related
to a repair which is the primary intent of the service (see Repair guidelines), or when no more specific codes are
available. When performing debridement of a single wound, report depth using the deepest level of tissue removed.
In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from
different depths. For example: When bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer,
report the work with a single code, 11044. When subcutaneous tissue is debrided from a 16 sq cm dehisced
abdominal wound and a 10 sq cm thigh wound, report the work with 11042 for the first 20 sq cm and 11045X for
the second 6 sq cm. If all four wounds were debrided on the same day, use modifier 59 with 11042 and 11045X and
11044.
(For dermabrasions, see 15780-15783)
(For nail debridement, see 11720-11721)
(For burn(s), see 16000-16035)
(For pressure ulcers, see 15920-15999)
11040
11041
Debridement; skin, partial thickness
skin, full thickness
(11040, 11041 have been deleted)
(For debridement of skin, ie, epidermis and/or dermis only, see 97597 and 97598)
(For active wound care management, see 97597-97598)
(For debridement of burn wounds, see 16020-16030)
11042
Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square
centimeters or less
(For debridement of skin, ie, epidermis and/or dermis only, see 97597 and 97598)
+11045X
each additional 20 square centimeters, or part thereof (List separately in addition to code for
primary procedure)
(Use 11045X in conjunction with 11042)
11043
+11046X
Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed);
first 20 square centimeters or less
each additional 20 square centimeters, or part thereof (List separately in addition to code for
primary procedure)
(Use 11046X in conjunction with 11043)
11044
+11047X
Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if
performed); first 20 square centimeters or less
each additional 20 square centimeters, or part thereof (List separately in addition to code for
primary procedure)
(Use 11047X in conjunction with 11044)
(Do not report 11042-11047X in conjunction with 97597-97602 for the same wound)
Please note that the definitions above and new/revised CPT code numbers and descriptors are not assigned, nor
exact wording finalized, until just prior to publication of the CPT manual. These new/revised definitions and codes
will not be effective until CPT 2011. Do not use this new/revised information prior to final publication.
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
This Survey is for revised codes 11043 and 11044.
Note that the global period will be changed from 10-days to 0-day.
Please consider these “typical patients” and the revised global period when completing this survey
Survey 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and
Code subcutaneous tissue, if performed); first 20 square centimeters or less
New
0 day
Global
Typical A 74-year-old diabetic female with limited mobility presents with a 4.0 cm x 3.5
Patient cm posterior heel ulceration involving the skin and subcutaneous tissues and
Achilles tendon/muscle. She requires debridement of the wound, including
debridement of the tendon/muscle.
Survey 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue,
Code muscle and/or fascia, if performed); first 20 square centimeters or less
New
0 day
Global
Typical A 67-year-old diabetic male with limited mobility presents with a 4.0 cm x 3.5 cm
Patient posterior heel ulceration involving the skin and subcutaneous tissues, Achilles
tendon/muscle, and calcaneus. He requires debridement of the wound, including
debridement of the tendon/muscle and calcaneus.
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Financial Disclosure:
Do you or a family member have a direct financial interest in the procedure(s) shown above, other
than providing these procedure(s) in the course of patient care? [Family member means spouse,
domestic partner, parent, child, brother, or sister. Disclosure of family member’s interest applies to the
extent known by you.]
For each question
For purposes of this survey “direct financial interest” means:
Check yes or no
1. A financial ownership interest in an organization* of 5% or more?
Yes
No
2. A financial ownership interest in an organization* which contributes materially**
to your income?
Yes
No
3. Ability to exercise stock options in an organization* now or in the future ?
Yes
No
Yes
No
Yes
No
4. A position as proprietor, director, managing partner, or key employee in an
organization*?
5. Serve as a consultant, researcher, expert witness (excluding professional liability
testimony), speaker or writer for an organization*, where payment contributes
materially** to your income?
* Organization means any entity that makes or distributes the product that is utilized in performing the
procedure/service, and not the physician group or facility in which you work or perform the procedure/service.
** Materially means income of $10,000 or more (excluding any reimbursement for expenses) for the past 24
months.
If you have answered YES to ANY of the financial disclosure questions above, stop here and do not
complete this survey.
If you have answered NO to ALL financial disclosure questions above, please continue to the next page
and complete the survey. We need your help to assure relative values will be accurately and fairly
presented to the Centers for Medicare and Medicaid Services (CMS) during this review process.
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Introduction
"Physician work" includes the following elements:




Physician time it takes to perform the service
Physician mental effort and judgment
Physician technical skill and physical effort, and
Physician psychological stress that occurs when an adverse outcome has serious
consequences
All of these elements will be explained in greater detail as you complete this survey.
"Physician work" does not include the services provided by support staff who are employed by your
practice and cannot bill separately, including registered nurses, licensed practical nurses, medical
secretaries, receptionists, and technicians; these services are included in the practice expense relative
values, a different component of the RBRVS.
Background for Question 1
The Table in Question 1 presents reference services that have been selected for use as comparison services for this
survey because their relative values are sufficiently accurate and stable to compare with other services. The “work
RVU” column presents current Medicare fee schedule work RVUs (relative value units). In Question 1 you will be
asked to select one code from this list which is most similar to each surveyed CPT code descriptor and typical
patient/service.
It is very important to consider the global period when you are comparing the survey code to the reference
services. A service paid on a global basis includes:



visits and other physician services provided within 24 hours prior to the service;
provision of the service; and
visits and other physician services for a specified number of days after the service is provided.
The global periods listed refer to the number of post-service days of care that are included in the payment for the
service as determined by CMS for Medicare payment purposes.
000
0 days of post-service care are included in the work RVU
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
SURGERY 000 Global Period Discussion
Pre-service period
The pre-service period includes physician services provided from the day before the operative procedure until the
time of the operative procedure and may include the following:
• Hospital admission work-up.
• The pre-operative evaluation may include the procedural work-up, review of records, communicating with
other professionals, patient and family, and obtaining consent.
• Other pre-operative work may include dressing, scrubbing, and waiting before the operative procedure,
preparing patient and needed equipment for the operative procedure, positioning the patient and other “nonskin-to-skin” work in the OR.
The following services are not included:
• Consultation or evaluation at which the decision to provide the procedure was made (reported with mod-57).
• Distinct evaluation and management services provided in addition to the procedure (reported with mod-25).
• Mandated services (reported with modifier -32).
Intra-service period
The intra-service period includes all “skin-to-skin” work that is a necessary part of the procedure.
Post-service period
The post-service period includes services provided on the day of the procedure and may include the following:
Day of procedure: Post-operative care on day of the procedure, includes “non-skin-to-skin” work in the OR,
patient stabilization in the recovery room or special unit, communicating with the patient and other professionals
(including written and telephone reports and orders), and patient visits on the day of the operative procedure.
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Survey 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and
Code subcutaneous tissue, if performed); first 20 square centimeters or less
New
0 day
Global
Typical A 74-year-old diabetic female with limited mobility presents with a 4.0 cm x 3.5
Patient cm posterior heel ulceration involving the skin and subcutaneous tissues and
Achilles tendon/muscle. She requires debridement of the wound, including
debridement of the tendon/muscle.
Survey 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue,
Code muscle and/or fascia, if performed); first 20 square centimeters or less
New
0 day
Global
Typical A 67-year-old diabetic male with limited mobility presents with a 4.0 cm x 3.5 cm
Patient posterior heel ulceration involving the skin and subcutaneous tissues, Achilles
tendon/muscle, and calcaneus. He requires debridement of the wound, including
debridement of the tendon/muscle and calcaneus.
Question 1:
Which ONE of the Reference Services below is most similar to each procedure and patient
described above? You may choose one code for both procedures being surveyed or a different code for each
procedure.
Table 1. Multispecialty Reference Services
Place one "X" in each column to indicate your reference choice for each survey code.
Survey Codes
CPT
11043
Code
11044
29581
11100
99202
11730
11755
43450
DESCRIPTOR
Application of multi-layer venous wound compression system, below
knee
Biopsy of skin, subcutaneous tissue and/or mucous membrane
(including simple closure), unless otherwise listed; single lesion
Office or other outpatient visit for the evaluation and management of
a new patient, which requires these 3 key components: An expanded
problem focused history; An expanded problem focused examination;
Straightforward medical decision making. Usually, the presenting
problem(s) are of low to moderate severity. Physicians typically
spend 20 minutes face-to-face with the patient and/or family.
Avulsion of nail plate, partial or complete, simple; single
Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and
lateral nail folds) (separate procedure)
Dilation of esophagus, by unguided sound or bougie, single or
multiple passes
work
global
RVU
period
0.60
000
0.81
000
0.93
XXX
1.10
000
1.31
000
1.38
000
Table continues on next page 
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Table 1. Multispecialty Reference Services
(continued)
Survey Codes
CPT
11043
Code
11044
99214
36569
16025
99204
36556
15002
19103
DESCRIPTOR
Office or other outpatient visit for the evaluation and management of
an established patient, which requires at least 2 of these 3 key
components: A detailed history; A detailed examination; Medical
decision making of moderate complexity. Usually, the presenting
problem(s) are of moderate to high severity. Physicians typically
spend 25 minutes face-to-face with the patient and/or family.
Insertion of peripherally inserted central venous catheter (PICC),
without subcutaneous port or pump; age 5 years or older
Dressings and/or debridement of partial-thickness burns, initial or
subsequent; medium (eg, whole face or whole extremity, or 5% to
10% total body surface area)
Office or other outpatient visit for the evaluation and management of
a new patient, which requires these 3 key components: A
comprehensive history; A comprehensive examination; Medical
decision making of moderate complexity. Usually, the presenting
problem(s) are of moderate to high severity. Physicians typically
spend 45 minutes face-to-face with the patient and/or family.
Insertion of non-tunneled centrally inserted central venous catheter;
age 5 years or older
Surgical preparation or creation of recipient site by excision of open
wounds, burn eschar, or scar (including subcutaneous tissues), or
incisional release of scar contracture, trunk, arms, legs; first 100 sq
cm or 1% of body area of infants and children
Biopsy of breast; percutaneous, automated vacuum assisted or
rotating biopsy device, using imaging guidance
work
global
RVU
period
1.50
XXX
1.82
000
1.85
000
2.43
XXX
2.50
000
3.65
000
3.69
000
32550
Insertion of indwelling tunneled pleural catheter with cuff
4.17
000
15004
Surgical preparation or creation of recipient site by excision of open
wounds, burn eschar, or scar (including subcutaneous tissues), or
incisional release of scar contracture, face, scalp, eyelids, mouth,
neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first
100 sq cm or 1% of body area of infants and children
4.58
000
20902
Bone graft, any donor area; major or large
4.58
000
4.94
000
5.30
000
6.74
000
6.87
000
7.17
000
11011
45385
34812
11012
31600
Debridement including removal of foreign material associated with
open fracture(s) and/or dislocation(s); skin, subcutaneous tissue,
muscle fascia, and muscle
Colonoscopy, flexible, proximal to splenic flexure; with removal of
tumor(s), polyp(s), or other lesion(s) by snare technique
Open femoral artery exposure for delivery of endovascular
prosthesis, by groin incision, unilateral
Debridement including removal of foreign material associated with
open fracture(s) and/or dislocation(s); skin, subcutaneous tissue,
muscle fascia, muscle, and bone
Tracheostomy, planned (separate procedure);
CPT five-digit codes, two-digit number modifiers, and descriptions only are copyright by the American Medical Association. No payment schedules, fee
schedules, relative value units, scales, conversion factors, or components thereof are included in CPT. The AMA is not recommending that any specific
relative values, fees, payment schedules, or related listings be attached to CPT. Any relative value scales or relative listings assigned to CPT codes are not
those of the AMA, and the AMA is not recommending use of these relative values.
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Question 2A.
How much of your own time is required per patient treated for each of the following steps
in patient care related each procedure?
11043
44044
Day Before Procedure
Pre-service evaluation time:
minutes
Day of Procedure
Pre-service evaluation time:
minutes
Pre-service positioning time:
minutes
Pre-service scrub, dress, wait time:
minutes
Intra-service time (skin-to-skin):
minutes
Post-service time*
minutes
*Post-operative care on day of the procedure, includes “non-skin-to-skin” work in the OR, patient stabilization in
the recovery room or special unit and communicating with the patient and other professionals (including written and
telephone reports and orders), and patient visits on the day of the operative procedure.
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
Question 2B: Post-Operative Work – Please respond to the following questions based on your
typical experience for each survey code.
Typical for purpose of this survey means more than 50% of the time.
What is “Typical”?
11043
11044
(Check only one row for each code)
Typically performed in a hospital
Do you typically (>50%) perform
Typically performed in an ASC
this procedure in a hospital,
ASC or in your office?
Typically performed in my office
(Check only one row for each code)
If you typically perform this
procedure in a hospital, is your
patient discharged the same day,
kept overnight but less than 24
hours, or admitted to the
hospital?
Same-day discharge
Overnight, but stays less than 24 hrs
Admitted, stays more than 24 hrs
N/A – typically in ASC / office
(Check only one row for each code)
If your patient is typically kept
overnight in a hospital, will you
perform an E&M service later
on the same day?
Yes – E/M later same day
No – first E/M is next day
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
QUESTION 3:
For each Survey CPT code and for each reference service you chose in Question 1, rate
the AVERAGE pre-, intra-, and post service complexity/intensity on a scale of 1 to 5 (1 = low; 3 =medium; 5 =
high). Please base your rankings on the universe of codes your specialty performs.
Insert 1, 2, 3, 4, or 5 in each green cell below
(intensity rating scale: 1=low; 5=high)
Rate
11043
Rate
Ref Code
Rate
11044
Rate
Ref Code
PRE-service complexity
INTRA-service complexity
POST-service complexity
Discussion of Physician Work Complexity and Intensity
In evaluating the work of a service, it is helpful to identify and think about each of the components of a particular
service. Focus only on the work that you perform during each of the identified components. The descriptions
below are general in nature. Within the broad outlines presented, please think about the specific services that you
provide.
Physician work includes the following:
Time it takes to perform the service.
Mental Effort and Judgment necessary with respect to the amount of clinical data that needs to be
considered, the fund of knowledge required, the range of possible decisions, the number of factors
considered in making a decision, and the degree of complexity of the interaction of these factors.
Technical Skill required with respect to knowledge, training and actual experience necessary to
perform the service.
Physical Effort can be compared by dividing services into tasks and making the direct comparison
of tasks. In making the comparison, it is necessary to show that the differences in physical effort are
not reflected accurately by differences in the time involved; if they are, considerations of physical
effort amount to double counting of physician work in the service.
Psychological Stress – Two kinds of psychological stress are usually associated with physician
work. The first is the pressure involved when the outcome is heavily dependent upon skill and
judgment and an adverse outcome has serious consequences. The second is related to unpleasant
conditions connected with the work that are not affected by skill or judgment. These circumstances
would include situations with high rates of mortality or morbidity regardless of the physician’s skill
or judgment, difficult patients or families, or physician physical discomfort. Of the two forms of
stress, only the former is fully accepted as an aspect of work; many consider the latter to be a highly
variable function of physician personality.
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CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.
QUESTION 4:
For each Survey CPT code and for each reference service you chose in Question 1, rate
the intensity for each component listed on a scale of 1 to 5. (1= low; 3=medium; 5 = high). Please base your
rankings on the universe of codes your specialty performs.
Insert 1, 2, 3, 4, or 5 in each green cell
(intensity rating scale: 1=low; 5=high)
Rate
Rate
Rate
Rate
11043
Ref Code
11044
Ref Code
Mental Effort and Judgment
The number of possible diagnoses and/or the number of management
options that must be considered
The amount and/or complexity of medical records, diagnostic tests,
and/or other information that must be obtained reviewed and analyzed
Urgency of medical decision making
Technical Skill/Physical Effort
Technical skill required
Physical effort required
Psychological Stress
The risk of significant complications, morbidity and/or mortality
Outcome depends on skill and judgment of physician
Estimated risk of malpractice suit with poor outcome
Moderate sedation is a service provided by the operating physician or under the direct supervision of the physician
performing the procedure to allow for sedation of the patient with or without analgesia through administration of
medications via the intravenous, intramuscular, inhalational, oral, rectal or intranasal routes. For purposes of the
following question, sedation and analgesia delivered separately by an anesthesiologist or other anesthesia provider
not performing the primary procedure is not considered moderate sedation.
QUESTION 5:
Do you or does someone under your direct supervision typically administer moderate
sedation for these procedures when performed in the Hospital/Ambulatory Surgicenter (ASC) setting or in
the Office Setting?
In theHospital/ASC?
Yes
No
In the Office?
Yes
No
11043
Your Ref Code
11044
Your Ref Code
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QUESTION 6:
Experience - How many times in the past 12 months have you performed each survey
code procedure and each reference code procedure?
11043 experience:

Ref 1 experience:
11044 experience:

Ref 2 experience:
QUESTION 7:
Is your typical patient for each code similar to the typical patient described at the
beginning of the survey?
11043
11044
YES?
NO?
If "No," please describe your typical patient below:
YES?
NO?
If "No," please describe your typical patient below:
******************************VERY IMPORTANT******************************
QUESTION 8: Based on your review of all previous steps, please provide your estimated work
RVU for the survey CPT codes.
Estimated*
work RVU:
11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and
subcutaneous tissue, if performed); first 20 square centimeters or less
11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue,
muscle and/or fascia, if performed); first 20 square centimeters or less
* For example, if the new/revised code involves the same amount of physician work as the reference service
you choose, you would assign the same work RVU. If the new or revised code involves less work than the
reference service you would estimate a work RVU that is less than the work RVU of the reference service and viceversa. This methodology attempts to set the work RVU of the new/revised service “relative” to the work RVU of
comparable and established reference services. Please keep in mind the range of work RVUs for the reference
codes listed in Question 1 above when providing your estimate.
Please email your completed survey to: [email protected]
THANK YOU!
CPT five-digit codes, two-digit modifiers, and descriptions only are copyright by the American Medical Association.