Scrub Away Debridement Billing Confusion
Know when to bill for debridement separately from surgery.
Debridement removes foreign material and/or devitalized or contaminated tissue until healthy tissue is exposed. It essentially cleans up the area and is often performed with other orthopedic surgical procedures. As an auditor who specializes in orthopedics, I frequently see providers bill for debridement in addition to extensive surgery. For billing purposes, however, debridement is generally considered a component of a more extensive procedure.
Per National Correct Coding Initiative (NCCI) Policy Manual, Chapter 4, under General Policy Statements, “Debridement of tissue in the surgical field of another musculoskeletal procedure is not separately reportable.”
Sounds easy enough, right? Think again. As with all things ortho coding related, just when you think you understand a concept well, there are exceptions to remember. In this case, there are three instances in which you can, and should, bill for a debridement procedure separately from a surgical procedure.
1. Debridement at the Site of an Open Fracture or Dislocation
Open fracture pertains to the diagnosis (bone sticking through the skin), not the type of repair or procedure (e.g., open reduction). When debridement is performed at an open fracture or dislocation site, look to CPT® code range 11010-11012 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation). Bill the procedure in addition to any fracture treatment code(s).
2. Arthroscopic Shoulder Debridement
Debridement is generally included with other arthroscopic shoulder procedures, even when performed in different areas of the shoulder. However, you can bill extensive debridement (29823), which is defined as … 3 or more discrete structures (eg, 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, foreign body[ies]), with 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 when performed in different areas of the shoulder.
It should be noted that between the dates of Oct. 1, 2022, and Dec. 31, 2022, there was an NCCI edit that bundled 29823 with the abovementioned procedures. However, that edit was removed as of Jan. 1, 2023, so no modifier is required other than the anatomical modifier for these code pairs.
3. Arthroscopic Knee Debridement
In general, you can separately bill arthroscopic debridement/chondroplasty of the knee when it is performed in a separate compartment. There is an NCCI edit, however, bundling 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) with all other knee scope procedure codes (29866-29889), which cannot be overridden. Instead, when debridement or loose body removal is performed in a different compartment, consider whether you can use HCPCS Level II code G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee.
Of course, there is an exception to the exception, which is seen with 29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed and 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed. Since the descriptions of these procedures include “chondroplasty in the same OR separate compartment,” you cannot report G0289 for debridement/chondroplasty when performed with a meniscectomy, regardless of which compartment is treated. You can, however, bill G0289 for loose body removal when a meniscectomy is performed, as long as the loose body is removed from a separate compartment