Wound Care - Are you Using the Most Appropriate Codes?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Mar 9th, 2015 - Reviewed/Updated Aug 9th

If you often use 11042-11047, be sure you are using the correct codes. If you are preparing the site for surgery, these would not be the correct codes to use. In addition, when using codes 11042-11047, be sure to document the size of the wound; use this set of codes only if this would be a positive outcome for a chronic wound.  

If the physician is preparing a clean, viable wound in preparation for a skin graft, skin substitute or negative pressure wound therapy, you need to consider other codes, such as 15002-15005. These codes are used for primary intention, which means this is the care method used for acute injuries that close the wound with graft or stitches.

Secondary intention promotes healing from the inside out for wounds such as diabetic or venous ulcers.

For negative pressure wound therapy, providers may elect to use primary or secondary closure.

When treating necrotizing tissue, use 11004-11008 code series.

For wounds encompassing the trunk, arms, or legs, use 15002-15003.  

For the face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits, according to the descriptors, use 15004-15005.

Select the appropriate code by:

           1) location

           2) the size and area treated.

There are additional add-on codes, 15002 and 15003, that may be used if necessary. For example, if treating the hands and face, you would sum the total area of both. If you are treating abrasions to the forearm and hands, you would not sum the total area but would bill two separate codes. If you are treating a child that is 9 years and under, you select the codes based on the percentage of the body surface instead of sq. centimeters.