From the Editor: The Debridement Issue

  This issue of TWC focuses on wound debridement because the codes for billing debridement services changed January 1, 2011. If you missed this newsflash, then you desperately need this issue of TWC. Debridement may be among the most controversial topics in wound care—but not because anyone disputes its importance to healing. There is overwhelming clinical data that clean wounds are less likely to become infected and more likely to heal than wounds which have necrotic tissue. Furthermore, there are mechanical disadvantages to some types of viable tissue such as rolled wound edges and areas of undermining or tunneling. The removal or un-roofing of these areas of skin and subcutaneous tissue provides important biochemical signaling and structural advantages to the process of angiogenesis and epithelializataion. So, what is all the fuss about?

  In May 2007, the Office of the Inspector General (OIG) released a report on Medicare payments for debridement services in 2004. That year Medicare estimated that $64 million of the $188 million dollars paid out for “exicisional surgical debridement procedures” did not meet program requirements and were thus “improper payments” (see my article for more information).

  If these problems had been due only to poor documentation, CMS might not have been compelled to change the mechanism of billing for debridement. However, the review raised concern that, “some of these services might have been part of an inappropriate pattern.” Most of the clinicians I know want to do what is best for their patients, and I don’t know any clinicians who perform procedures which are clearly unwarranted. The problem seems to have occurred where clinical practice intersects documentation and billing for those procedures. A variety of external forces seem to have driven either the frequency or the manner in which debridement services have been charged. Artificially inflating either debridement procedures or charges as a way to fuel wound center revenue is neither medically appropriate nor ethically acceptable. Debridement should be performed when the wound needs it, and not on any sort of arbitrary schedule or protocol (weekly or bimonthly). It should be billed according to the type of tissue removed and not the tissue one sees after debridement. And, according to the new billing guidelines, it is also billed according to the total surface area debrided rather than by the individual wound.

  Kathleen Schaum’s “In Business” article meticulously describes the new codes and how they are used. I have tried to provide some clinical context for these codes in my article. Also in this issue is information about wound care products which may be used in conjunction with debridement procedures. Wound debridement billing is a complex and confusing topic. We hope that this issue of TWC will provide some much needed clarity and will serve as your clinic’s primary reference as you begin to use the 2011 debridement codes.

Caroline Fife, Co-Editor of TWC, cfife@intellicure.com