Lateriality. Documentation stating "excisional debridement" is not enough to code excisional debridement. The AHA Coding Clinic for ICD-9-CM has provided much guidance on when to code ICD-9 Code 86.22, Excisional debridement of wound, infection or burn.
For example: Bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer. This is reported with a single code, 11044.
If a non-excisional debridement was done the code would be 0HDMXZZ Extraction of right foot skin, external
Debridement fits into two different root operations, depending on the method used: excision and extraction. If you look up debridement in the ICD-10 index you will find: Excisional see Excision. Non-excisional see Extraction. The definitions from CMS are as follows: Excision: Cutting out or off, without replacement, a portion of a body part.
If an excisional debridement the code would be 0HBMXZZ Excision of right foot skin, external approach. Example: Excisional debridement of skin, subcutaneous tissue, and muscle of buttocks. (Accounting for laterality), 0KBP3ZZ Excision of left hip muscle, percutaneous approach.
For excisional debridement of muscle or fascia, coders would report CPT code 11043 (debridement, muscle or fascia [includes epidermis, dermis, and subcutaneous tissue, if performed]; first 20 sq. cm or less) for the first 20 sq. cm and add-on code 11046 (debridement, muscle or fascia; each additional 20 sq.
One thing to keep in mind, is the difference between an excisional debridement and a non-excisional debridement. An excisional debridement: Is a surgical procedure that involves an excisional method of removal, or cutting away tissue, necrosis and/or slough. Groups to a surgical MS-DRG.
Bone debridement is the surgical process of removing skin and bone close to and surrounding an infected wound associated with bone injuries or diseases. This procedure involves the removal of several layers of the skin, the subcutaneous tissue, associated muscles, fascia, and any foreign matter embedded in the wound.
An excisional debridement of the skin or subcutaneous tissue is the surgical removal or cutting away of such tissue, necrosis, or slough and is classified to the root operation Excision. Excisional debridement involves the use of a scalpel to remove devitalized tissue.
Surgical removal or cutting away of devitalized tissue, necrosis, or slough. down to viable tissue using a blade/scalpel (not scissors), and outside or beyond wound margin.
The use of a VersaJet, without additional surgical cutting away of tissue is classified as non-excisional.
Debridement is the word used to describe a specific surgical procedure. In a debridement, the surgeon removes damaged tissue from the body to promote healing. Tissue removed may be: Dead.
Wound debridement codes (not associated with fractures) are reported with CPT codes 11042-11047. Wound debridements are reported by the depth of tissue that is removed and the surface area of the wound. These services may be reported for injuries, infections, wounds, and chronic ulcers.
These include surgical debridement, biological debridement, enzymatic debridements, and autolytic debridement.Autolytic Debridement. This is the most conservative type of debridement. ... Biological Debridement. ... Enzymatic Debridement. ... Surgical Debridement with Sharp Instruments. ... Mechanical Debridement.
the 13160 includes the debridement and closure of the wound.
Types of DebridementSurgical Debridement (Sharp = Selective)Enzymatic Debridement (Selective)Autolytic (Selective)Biological (Selective)Mechanical (Nonselective)Irrigation (Nonselective)
The AHA Coding Clinic for ICD-9-CM has provided much guidance on when to code ICD-9 Code 86.22, Excisional debridement of wound, infection or burn. The information from 1988 to 2005 specifies that the code applies to the surgical removal or cutting away rather than scrubbing, scraping, brushing, washing or snipping away bits of tissue with scissors. Therefore, applying the guidance, one would be geared towards reporting an excisional debridement when a portion of a body part is cut out or off using a sharp instrument, such as a scalpel, wire, scissors, a bone saw, electrocautery tip or a sharp curette provided the documentation in the medical record also supported the procedure. The other important thing to remember, which most forget, is that the coding clinic provided guidance in cutting tissue outside or beyond the wound margin. The first quarter 2004 Coding Clinic further defined excisional debridement to involve cutting outside or beyond the wound margin in removing devitalized tissue. Documentation should clearly indicate that the procedure involves cutting outside or beyond the wound margin. If in doubt, look for a specimen being sent to the lab.
What is A.11? Convention A.11, states: "Many of the terms used to construct PCS codes are defined within the system. It is the coder's responsibility to determine what the documeta- tion in the medical record equates to in the PCS definitions.
Also remember that excisional debridement is not necessarily exclusive to the operating room. It can be done at bedside, or in the emergency department. From a coding perspective as to which one, excisional vs. non-excisional, may apply, ponder on the inpatient example in which a patient is found to have a decubitus ulcer requiring and excisional debridement. This patient is likely to require a longer hospital stay than one who only needs a round of antibiotics and Silvadene with regular dressing changes.
An excisional debridement of the skin or subcutaneous tissue is the surgical removal or cutting away of such tissue, necrosis, or slough and is classified to the root operation Excision. Excisional debridement involves the use of a scalpel to remove devitalized tissue.
Debridement can be categorized as excisional or non- excisional.”. The same Coding Clinic further directs the coder to code excisional debridement when either “the provider documents ‘excisional debridement’ in the body of the operative report, and/or the documentation meets the root operation definition of ‘Excision.’”.
The advice published in Coding Clinic, Second Quarter 2000, page 9, is still valid. Code 86.22, Excisional debridement of wound, infection, or burn, should be assigned when a provider, such as a physical therapist documents "excisional debridement ," in the health record. It is appropriate to assign a procedure code based on documentation by a nonphysician professional when that professional provides the service. This may be the only evidence that the service was provided. Historically, infusions (i.e., codes 99.29, 99.20, etc.) when carried out by a nurse have been coded. This same advice applies for drugs that are ordered by the physician, then administered and documented in the record by a nurse. See Coding Clinic, First Quarter 1997, pages 3 to 4, and Fourth Quarter 1998, pages 85-86, for examples of intravenous infusions. Please note this only applies to procedure coding where there is documentation to substantiate the code. This advice does not apply to diagnosis coding.
According to Coding Clinic, Second Quarter 2000, page 9, it is appropriate to assign code 86.22, Excisional debridement of wound, infection, or burn, when a health care provider such as a physical therapist performs an excisional debridement. However, Coding Clinic has also advised that code assignment is only based on physician documentation. For coding purposes, when the physical therapist documents "excisional debridement" must the attending countersign or confirm this procedure in the medical record? ...
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Per Coding Clinic 1, the body part value for an excisional debridement performed on a muscle in the sacral region is the “Hip muscle.” If the documentation specifies that the right side or left side of the sacral ulcer was debrided, then a single code can be assigned. If the documentation does not specify laterality, assign codes for both the right and left hip muscles.
ICD-10 only requires one code to be assigned for the pressure ulcer and stage (ICD-9 required two separate codes)
The procedure code may have been overlooked because the surgeon documented that the tissue was “excised” rather than documenting that an “excisional debridement” was performed. Documentation of “excision” or “excised” is sufficient to code PCS root operation: Excision.
Coding Clinic likely allows coders to assume both the right and left hip muscles when laterality is not specified because sacral pressure ulcers often develop on the lower back which would include portions of the left and right hips
The depth of the non-pressure ulcer does not change the CC designation (non-pressure ulcers involving the skin, fat, muscle, bone, or unspecified are all designated as CCs)
The original coder did not code the diabetic foot ulcer excision. Adding the excision would drive the case from a medical DRG (638) to a surgical DRG (623) Non-pressure ulcers of the leg (thigh, calf, ankle, heel, midfoot) except the toes are CCs.
Rather, it is removal of devitalized tissue, necrosis, and slough by other methods, including: Examples of non-excisional debridement are pulsed lavage, mechanical lavage, mechanical irrigation, high-pressure irrigation, etc.
When performing debridement of a single wound, report depth using the deepest level of tissue removed. In multiple wounds, sum the surface area of those wounds that are at the same depth, but do not combine sums from different depths. For example: Bone is debrided from a 4 sq cm heel ulcer and from a 10 sq cm ischial ulcer.
For instance, Versajet™ debridement is considered to be nonsurgical, mechanical debridement because it does not involve cutting away or excising devitalized tissue. Likewise, the Arobella Qoustic Wound Therapy System™ uses an ultrasonic assisted curette to debride wounds mechanically. Author. Recent Posts.
Complete documentation for excisional debridement requires five elements: A description of the procedure as “excisional”. A description of the instrument used to cut or excise the tissue (e.g., scissors, scalpel, curette) A description of the tissue removed (e.g., necrotic, devitalized or non-viable)
For example, using a sharp instrument does not necessarily indicate that an excisional debridement was performed. Documentation needs to describe the sharp debridement as a definite cutting away of devitalized tissue that includes cutting outside or beyond the wound margin.
Nonexcisional debridement is described as non-surgical because it does not involve cutting away or excising devitalized tissue. It is described as removal of devitalized tissue, necrosis, and slough by other methods, such as: Scrubbing. Washing.