Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Add-on debridement code billed without initial debridement code same session
Common11045 (debridement muscle/fascia, each additional 20 sq cm) is add-on code requiring initial debridement code 11043 same session. Cannot bill 11045 alone. For debridement >20 sq cm at muscle/fascia depth, bill: 11043 (first 20 sq cm) + 11045 for each additional 20 sq cm. Must document total area.
Common Causes
- • Billed 11045 without 11043 - add-on code requires base code
- • Total area 25 sq cm - should bill 11043 + 11045, not just 11045
- • Multiple separate wounds - may need multiple 11043 codes or add areas if same session
Resolution Strategy
Verify initial code: Must bill 11043 (first 20 sq cm) before 11045. Example: 45 sq cm debridement = 11043 + 11045 x2 (20 + 20 + 5 rounds up to next 20). Document total area: 'Debridement of leg wound, 45 sq cm total area (9cm x 5cm), sharp excision of necrotic fascia and muscle.' If only 15 sq cm total, bill 11043 only. Cannot bill 11045 without 11043 same session.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For each additional 20 sq cm of subcutaneous debridement beyond the first 20 sq cm coded with 11042
Common Scenarios
Documentation Requirements
- Total area debrided documented
- Break down by anatomic location if multiple
- Tissue depth and type removed
- Medical necessity for extent
Coding Guidelines
Common Modifiers
Bundling Rules
- Must report with 11042
- List separately add-on code
- Report for each additional 20 sq cm or part
Exclusions
- Cannot report without 11042
- Muscle level uses 11046
- First 20 sq cm uses 11042
Coding Notes
Clinical scenarios
- Total area debrided documented
- Break down by anatomic location if multiple
- Tissue depth and type removed
- Total area debrided documented
- Break down by anatomic location if multiple
- Tissue depth and type removed
- Total area debrided documented
- Break down by anatomic location if multiple
- Tissue depth and type removed
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Code Details
Medicare Pricing
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Ask a QuestionFrequently Asked Questions
CPT 11045 is the billing code for "Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof". For each additional 20 sq cm of subcutaneous debridement beyond the first 20 sq cm coded with 11042
Medicare pays approximately $38.49 for CPT 11045 (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 11045 has a total RVU of 1.87, broken down as: Work RVU 0.84, Practice Expense RVU 0.95, and Malpractice RVU 0.08. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 11045 is "Add-on debridement code billed without initial debridement code same session". 11045 (debridement muscle/fascia, each additional 20 sq cm) is add-on code requiring initial debridement code 11043 same session. Cannot bill 11045 alone. For debridement >20 sq cm at muscle/fascia depth, bill: 11043 (first 20 sq cm) + 11045 for each additional 20 sq cm. Must document total area. Common causes include: Billed 11045 without 11043 - add-on code requires base code; Total area 25 sq cm - should bill 11043 + 11045, not just 11045. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 11045 include: Total area debrided documented; Break down by anatomic location if multiple; Tissue depth and type removed; Medical necessity for extent. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 11045: Must report with 11042. List separately add-on code Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 11045 include: 59 (Distinct procedural service if needed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 11045 is 10-15 minutes per additional 20 sq cm. Time-based codes require documentation of the actual time spent providing the service.