Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Debridement depth documentation insufficient - muscle/fascia layer not confirmed
Very Common11043 (debridement muscle/fascia, first 20 sq cm) requires documented debridement reaching muscle or fascia layer - deeper than subcutaneous tissue (11042). Denied when depth not specified, when only subcutaneous tissue debrided, or when size not documented. Higher reimbursement than 11042 - requires clear depth documentation.
Common Causes
- • Documentation states 'deep debridement' without specifying fascia/muscle reached
- • Subcutaneous tissue debrided but fascia not reached - should be 11042
- • Depth progression not documented (skin → subcu → fascia → muscle)
Resolution Strategy
Document fascia/muscle depth: 'Wound right lower leg with extensive necrotic tissue. Sharp debridement performed removing devitalized skin, subcutaneous fat, and fascia (exposed tibialis anterior muscle). Approximately 18 sq cm debrided (6cm x 3cm). Hemostasis achieved, wound packed.' Must specify: depth reached (fascia or muscle explicitly stated), size of debrided area, sharp technique used. If only subcutaneous depth, rebill as 11042. Cannot appeal without documented fascia/muscle involvement.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For debridement extending to muscle and/or fascia in wounds up to 20 sq cm
Common Scenarios
Documentation Requirements
- Location and size of debrided area
- Depth of debridement (muscle/fascia)
- Type of tissue removed
- Viability of remaining tissue
- Any complications
Coding Guidelines
Common Modifiers
Bundling Rules
- Includes debridement of muscle and/or fascia
- Includes overlying soft tissue if removed
- Wound closure coded separately
- Dressing changes bundled
- Multiple sites debrided coded separately
Exclusions
- 11042 (debridement of subcutaneous tissue only)
- 11044 (debridement of bone)
- 97597 (debridement of wound)
Coding Notes
Clinical scenarios
- Location and size of debrided area
- Depth of debridement (muscle/fascia)
- Type of tissue removed
- Location and size of debrided area
- Depth of debridement (muscle/fascia)
- Type of tissue removed
- Location and size of debrided area
- Depth of debridement (muscle/fascia)
- Type of tissue removed
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 11043 is the billing code for "Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less". For debridement extending to muscle and/or fascia in wounds up to 20 sq cm
Medicare pays approximately $225.46 for CPT 11043 (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 11043 has a total RVU of 8.05, broken down as: Work RVU 3.50, Practice Expense RVU 4.20, and Malpractice RVU 0.35. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 11043 is "Debridement depth documentation insufficient - muscle/fascia layer not confirmed". 11043 (debridement muscle/fascia, first 20 sq cm) requires documented debridement reaching muscle or fascia layer - deeper than subcutaneous tissue (11042). Denied when depth not specified, when only subcutaneous tissue debrided, or when size not documented. Higher reimbursement than 11042 - requires clear depth documentation. Common causes include: Documentation states 'deep debridement' without specifying fascia/muscle reached; Subcutaneous tissue debrided but fascia not reached - should be 11042. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 11043 include: Location and size of debrided area; Depth of debridement (muscle/fascia); Type of tissue removed; Viability of remaining tissue. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 11043: Includes debridement of muscle and/or fascia. Includes overlying soft tissue if removed Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 11043 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 11043 is 20-40 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.