CPT Code 11047: A Complete Guide for Medical Professionals, Billers, and Coders
Wound care is one of the most complex and critical areas in healthcare, especially when it comes to coding and billing. Among the many CPT codes used for debridement procedures, CPT Code 11047 plays a significant role. It is often reported alongside other wound care codes and comes with specific rules, documentation requirements, and billing guidelines.
Our this blog provides a comprehensive deep dive into CPT Code 11047, we will define the code, it’s usage, guideline, modifiers, payer policies, tables for comparison, and real-world scenarios. By the end, you will have a strong grasp of what CPT 11047 is, how it should be billed, why it matters, and what pitfalls to avoid.
What is CPT Code 11047?
CPT Code 11047 is defined as:
“Debridement, open wound (e.g., fibrin, devitalized epidermis and dermis, exudate, debris), including epidermis, dermis, subcutaneous tissue, muscle and/or bone, each additional 20 sq cm or part thereof.”
- Category: Surgical procedure code
- Type: Add-on code (never billed alone)
- Scope: Used for each additional 20 sq cm when debridement includes subcutaneous tissue, muscle, and/or bone.
- Primary Codes Required: Must be billed in conjunction with 11043 (muscle debridement, first 20 sq cm) or 11044 (bone debridement, first 20 sq cm).
How Does CPT 11047 Differ from Other Debridement Codes?
The 1104x series is specific to deeper levels of tissue debridement:
| CPT Code | Description | Size Unit | Primary or Add-On |
| 11042 | Debridement involving subcutaneous tissue | First 20 sq cm | Primary |
| 11045 | Each additional 20 sq cm (subcutaneous) | Add-on | Add-On |
| 11043 | Debridement involving muscle | First 20 sq cm | Primary |
| 11046 | Each additional 20 sq cm (muscle) | Add-on | Add-On |
| 11044 | Debridement involving bone | First 20 sq cm | Primary |
| 11047 | Each additional 20 sq cm (bone/muscle extension) | Add-on | Add-On |
Image for clarification, please do no use this image in the blog
Why Is CPT 11047 Important in Wound Care?
CPT 11047 is crucial for accurate reimbursement in advanced wound care cases:
- Reflects Complexity – Large wounds often extend beyond 20 sq cm; 11047 ensures additional work is recognized.
- Supports Clinical Documentation – Indicates that bone or deep muscle was involved in the wound, showing severity.
- Ensures Proper Reimbursement – Without add-on codes like 11047, providers risk under-billing.
- Compliance with Coding Rules – Billing 11047 without a primary code can lead to denials or audits.
How to Correctly Report CPT Code 11047
When reporting CPT code 11047, “Debridement, including removal of foreign material, of bone (e.g., osteomyelitis),” it is important to accurately describe the extent and depth of the debridement performed. This code should be used for extensive debridement procedures that reach the bone, and it must be accompanied by detailed documentation supporting the medical necessity of this deep debridement. To report 11047 correctly, follow these steps:
- Start with a primary code – Use 11043 or 11044 depending on the initial wound depth.
- Measure wound size – Document wound surface area in square centimeters.
- Calculate additional area – For every additional 20 sq cm, append one unit of 11047.
- Bill as an add-on code – Ensure 11047 is always listed with the primary code.
Example Scenarios for CPT 11047
| Scenario | Correct Code(s) | Explanation |
| Wound debridement of 25 sq cm muscle | 11043 + 11046 | First 20 sq cm → 11043; Additional 5 sq cm → 11046 |
| Wound debridement of 45 sq cm bone | 11044 + 11047 x 2 | First 20 sq cm → 11044; Remaining 25 sq cm → two units of 11047 |
| Wound debridement of 60 sq cm bone | 11044 + 11047 x 2 | First 20 sq cm → 11044; Additional 40 sq cm → two units of 11047 |
What Documentation Is Required for 11047?
Documentation is critical for reimbursement. A proper operative note or wound care note should include:
- Wound dimensions (length, width, depth, total area in sq cm).
- Tissue type debrided (subcutaneous, muscle, bone).
- Extent of procedure (tools used, amount of tissue removed).
- Medical necessity (infection risk, necrotic tissue, wound progression).
- Physician signature and date.
How Do Payers View CPT 11047?
Medicare Guidelines
- Covered when medically necessary.
- Bundled with some services (E/M unless modifier -25 is applied).
- Global surgical rules may apply if related to recent procedures.
Commercial Payers
- Vary widely – some require pre-authorization for extensive wound care.
- Often require clear photographic documentation for large wounds.
What Modifiers Apply to CPT 11047?
To properly report CPT code 11047, you must use modifiers that accurately describe the procedure’s context. The most common modifiers for this code are those that indicate multiple procedures, staged procedures, or a distinct procedural service.
Common Modifiers for CPT 11047
- Modifier 59: This is used to indicate a Distinct Procedural Service. It’s applied when debridement is performed on a different site or a separate incision is made from another procedure done on the same day. For example, if you debride a wound on the patient’s arm and also perform a separate unrelated procedure on their leg, you would use modifier 59.
- Modifier 58: This modifier signifies a Staged or Related Procedure by the same physician during the postoperative period. You would use this if the patient needs to return for a subsequent debridement on the same wound within the global surgical period.
- Modifier 78: This modifier is used for an Unplanned Return to the Operating Room for a related procedure during the postoperative period. If a patient experiences a complication, like an infection, and needs an immediate follow-up debridement, this modifier is appropriate.
- Modifier 79: This indicates an Unrelated Procedure or Service by the same physician during the postoperative period. It’s used if a different, unrelated surgical procedure is performed on the same patient during the global period of the initial surgery.
How Many Units of 11047 Can You Bill?
- Bill one unit per additional 20 sq cm (or part thereof).
- For large wounds (e.g., 100 sq cm bone debridement), billing may include multiple 11047 units.
- Medicare may apply Medically Unlikely Edits (MUEs), typically limiting units unless documentation strongly supports medical necessity.
Common Denials and How to Avoid Them
Two common reasons for CPT code 11047 denials are lack of medical necessity documentation and incorrect use of modifiers. To avoid these denials, ensure your clinical notes clearly support the need for debridement down to the bone, and always apply the correct modifiers, such as 59, 58, or 78, to accurately describe the procedure’s context and prevent bundling issues.
| Denial Reason | Prevention |
| 11047 billed without 11043/11044 | Always include a primary code. |
| Insufficient wound documentation | Record size, depth, tissue type. |
| Exceeding MUE limits | Justify medical necessity with photos/notes. |
| Bundled with E/M | Append modifier -25 when appropriate. |
Clinical Considerations in Debridement
For CPT code 11047, clinical considerations involve documenting the medical necessity and depth of the debridement. The provider must clearly state that the procedure went down to the bone and was necessary to remove infected, dead, or non-viable tissue to promote healing and prevent further complications.
- Bone involvement → Often associated with osteomyelitis or severe chronic ulcers.
- Deep muscle debridement → Indicates advanced tissue necrosis.
- Multidisciplinary Care → Surgeons, wound care specialists, and infectious disease physicians often collaborate.
How to Calculate Wound Surface Area
Example:
- Wound 5 cm x 8 cm = 40 sq cm
- First 20 sq cm → Primary code
- Remaining 20 sq cm → Add-on (11047 if muscle/bone)
CPT 11047 vs. Debridement with Skin Substitutes
Sometimes confusion arises between 11047 wound debridement and application of skin substitutes (15271–15278).
| CPT 11047 | Skin Substitute Codes |
| Focus: Removing necrotic tissue | Focus: Applying graft/biologic material |
| Add-on code, linked to primary | Standalone codes |
| Measured in 20 sq cm increments | Measured per 100 sq cm |
Conclusion: Mastering CPT 11047 for Compliance and Revenue Integrity
CPT Code 11047 is essential for coding advanced wound care involving deep tissue, muscle, and bone. Its proper use ensures:
- Accurate representation of clinical work performed.
- Full reimbursement for extensive wound care services.
- Compliance with payer and Medicare rules.
By following documentation standards, payer-specific policies, and correct coding principles, providers and billers can minimize denials, improve revenue, and support high-quality wound care.
What does CPT Code 11047 represent, and when should it be used?
CPT Code 11047 represents “Debridement, open wound, including epidermis, dermis, subcutaneous tissue, muscle and/or bone, each additional 20 sq cm.” It is an add-on code that is reported when wound debridement extends beyond the initial 20 sq cm covered by a primary code (11043 for muscle or 11044 for bone). This code reflects the additional clinical work required for larger or more complex wounds.
Can CPT 11047 ever be billed as a primary code?
No. CPT 11047 cannot be billed alone because it is an add-on code. It must be reported in conjunction with 11043 or 11044. If submitted without a primary code, the claim will be denied. Think of 11047 as a “companion” code that only expands on an initial wound debridement procedure.
How is wound size calculated when billing 11047?
Wound size is measured in square centimeters (sq cm), calculated by multiplying the wound’s length by width. The first 20 sq cm is billed with a primary code (11043/11044). Any additional 20 sq cm or part thereof is billed with 11047.
What documentation is required to support CPT 11047?
Documentation must be detailed and precise, including:
- Exact wound dimensions (length, width, depth).
- Type of tissue removed (muscle, bone, necrotic material).
- Extent of debridement and method (scalpel, curette, etc.).
- Medical necessity (e.g., risk of infection, non-healing ulcer).
- Physician’s signature, date, and time.
Without these elements, insurers may deny claims.
What modifiers are commonly used with CPT 11047?
The most common modifiers include:
- -59: Distinct procedural service (used for multiple wounds).
- -25: Significant, separately identifiable E/M service performed on the same day.
- -76/-77: Repeat procedure (same or different provider).
- -78/-79: Procedures during postoperative period.
Proper use of modifiers helps avoid bundling denials and ensures correct payment.
Q6. How many units of 11047 can be billed in one session?
You can bill one unit of 11047 for every additional 20 sq cm of wound debridement after the initial 20 sq cm. For example:
- 80 sq cm debridement of bone → 11044 + 11047 x 3.
However, Medicare applies Medically Unlikely Edits (MUEs), typically limiting how many units can be billed unless strong clinical documentation supports higher amounts. Always justify with wound size, severity, and photos if possible.
How does CPT 11047 differ from 11046?
Both are add-on debridement codes, but:
- 11046 = Each additional 20 sq cm of muscle debridement.
- 11047 = Each additional 20 sq cm of bone debridement.
Since bone involvement is usually deeper and more complex, 11047 is tied to more severe wound cases such as osteomyelitis or chronic infected ulcers.
What are the most common reasons for denials of CPT 11047?
Frequent denial reasons include:
- Billed without 11043 or 11044 (no primary code).
- Missing or vague wound size documentation.
- Exceeding MUE limits without proper justification.
- Lack of clear evidence of muscle or bone involvement.
- Bundling issues with evaluation and management (E/M) services.
To avoid denials, providers should ensure detailed operative notes, use modifiers appropriately, and always link medical necessity.
Is CPT 11047 reimbursed by Medicare and commercial insurers?
Yes, Medicare and most commercial payers reimburse CPT 11047 when supported by medical necessity and proper documentation. However:
- Some insurers require preauthorization for extensive wound care.
- Photographs and wound progression notes may be requested.
- Global surgical rules may affect reimbursement if within a postoperative period.
Can multiple wounds be billed under CPT 11047 in the same session?
Yes, multiple wounds can be billed, but each wound must be documented and coded separately. If different wounds involve different depths (e.g., muscle in one wound, bone in another), report the correct primary and add-on codes for each. Modifier -59 may be required to show distinct wound sites and prevent bundling