Here are some clinical editing tips to keep in mind

Reporting and coding debridement of skin ulcers

• Debridement CPT codes *11043, *11044, *11046 and *11047 are specific to muscle, fascia or bone and shouldn’t be used when codes *11042 or *11045 are more appropriate.
• Codes *11042 and *11045 should be used when the debridement is performed on the subcutaneous tissue, including the epidermis and dermis (but not muscle, fascia or bone).
• These codes should be billed with a diagnosis code. Blue Cross Blue Shield of Michigan will review the diagnoses reported on these claims to make sure they’re appropriate for the corresponding CPT code description.
• Diagnosis codes should be reported with the appropriate stage of the pressure ulcer or non-pressure chronic ulcer diagnosis.

Diagnosis code specificity

• The diagnosis reported on claims should be specific and best reflect the condition for which the patient is being treated. Blue Cross performs clinical editing on services that may not have a diagnosis code reported at the highest level of specificity available.

If you have questions about the Blue Cross’ claim editing process, contact Provider Inquiry — Professional at 1-800-344-8525 or Provider Inquiry — Facility at 1-800-249-5103.