Billing and Coding: Debridement Services

Medicare claims for debridement services must include a valid ICD-10-CM diagnosis and, when required, the referring/ordering physician’s name and NPI; supporting documentation must include assessment, relevant history, test results, and signed visit/operative reports. Advance Beneficiary Notice rules apply for anticipated denials—use CMS-R-131 and the appropriate GA/GX/GY/GZ modifier as specified—and certain modifiers will cause automatic denial by Part A MAC systems; check NCCI and OPPS edits prior to billing.

"A valid ICD-10-CM diagnosis code that best describes the patient’s condition for which the debridement service was performed must be reported on the claim."

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