Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Debridement size/depth not documented to support code selection
Very Common11042 (debridement subcutaneous tissue, first 20 sq cm) requires documentation of: (1) depth (must reach subcutaneous tissue, not just skin), (2) size (square cm or estimated dimensions), (3) method (sharp debridement - not just cleaning). Denied when depth unclear or size not documented.
Common Causes
- • Documentation states 'wound cleaned' - that's not debridement unless devitalized tissue sharply removed
- • Depth not specified - unclear if reached subcutaneous tissue vs only skin removal
- • Size not documented - payer may downcode or deny
Resolution Strategy
Document debridement depth and size: 'Wound right lower leg with necrotic tissue. Sharp debridement performed using scalpel and scissors, removing devitalized subcutaneous tissue (reaching subcutaneous fat layer), approximately 15 sq cm area debrided (5cm x 3cm). Hemostasis achieved. Wound redressed.' Must specify: sharp debridement method, depth reached (subcutaneous tissue required for 11042), size of area debrided. If only skin-level debridement, may use 97597 (active wound care) instead. Cannot appeal without documented depth/size.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For debridement of subcutaneous tissue in wounds up to 20 sq cm
Common Scenarios
Documentation Requirements
- Location and size of debrided area
- Depth of debridement
- Type of tissue removed
- Appearance of wound after debridement
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes debridement of subcutaneous tissue
- Includes epidermis and dermis if removed
- Wound closure coded separately
- Dressing changes bundled
- Multiple sites debrided coded separately
Exclusions
- 11043 (debridement of muscle and fascia)
- 11044 (debridement of bone)
- 97597 (debridement of wound)
Coding Notes
Clinical scenarios
- Location and size of debrided area
- Depth of debridement
- Type of tissue removed
- Location and size of debrided area
- Depth of debridement
- Type of tissue removed
- Location and size of debrided area
- Depth of debridement
- Type of tissue removed
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Code Details
Medicare Pricing
PFSRVU Breakdown
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Ask a QuestionFrequently Asked Questions
CPT 11042 is the billing code for "Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less". For debridement of subcutaneous tissue in wounds up to 20 sq cm
Medicare pays approximately $125.18 for CPT 11042 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 11042 has a total RVU of 5.22, broken down as: Work RVU 2.20, Practice Expense RVU 2.80, and Malpractice RVU 0.22. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 11042 is "Debridement size/depth not documented to support code selection". 11042 (debridement subcutaneous tissue, first 20 sq cm) requires documentation of: (1) depth (must reach subcutaneous tissue, not just skin), (2) size (square cm or estimated dimensions), (3) method (sharp debridement - not just cleaning). Denied when depth unclear or size not documented. Common causes include: Documentation states 'wound cleaned' - that's not debridement unless devitalized tissue sharply removed; Depth not specified - unclear if reached subcutaneous tissue vs only skin removal. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 11042 include: Location and size of debrided area; Depth of debridement; Type of tissue removed; Appearance of wound after debridement. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 11042: Includes debridement of subcutaneous tissue. Includes epidermis and dermis if removed Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 11042 include: 51 (Multiple procedures performed same session), 59 (Distinct procedural service if performed separately), LT (Left side procedure). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 11042 is 15-30 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.