Facts to Avoid Confusion During Debridement Billing

 


Debridement is a process that involves the removal of foreign material, as well as tissue that is either devitalized or contaminated, until healthy tissue is revealed. Its primary purpose is to clean the affected area and is often performed concurrently with other orthopedic surgical interventions. In my role as an auditor specializing in orthopedics, I frequently encounter situations where healthcare providers submit claims for debridement in addition to extensive surgical procedures. Nevertheless, from a billing perspective, debridement is typically regarded as an integral component of a more comprehensive surgical procedure.

According to the National Correct Coding Initiative (NCCI) Policy Manual, Chapter 4, in its General Policy Statements section, it is stipulated that ‘Debridement of tissue in the surgical field of another musculoskeletal procedure is not separately billable.’

This may seem straightforward at first, but as is often the case with orthopedic coding, there are exceptions that require careful consideration. In this context, there are three specific scenarios in which it is both acceptable and advisable to bill for a debridement procedure separately from a surgical procedure.

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