Coding Challenge / General

Correctly Code Crush Injury of Hand

Question:
We have a patient who had a severe crush injury of the left hand which led to a comminuted fracture of the left 3rd and 5th metacarpals with an intra-articular fracture of the proximal phalanx of the left index finger.  The physician’s documentation indicates the following:

  • There was also a soft tissue defect over the left proximal interphalangeal (PIP) joint of the middle finger.  After taking samples for culture, the wounds were meticulously débrided and curetted.
  • Bony structures were evident over the 3rd metacarpal as well as on the PIP of the middle finger where the defect was about 3-1/2 to 2-1/2 inches. The area of the dorsum of the PIP joint of the left middle finger was about ¾ inch x ¾ inch.
  • Debridement and irrigation was done using 6 liters of saline with the gravity Patzakis technique and 1 liter of antibiotic.
  • After the wound was washed, X-rays were taken to confirm the fractures though no attempt was made to reduce any fractures because of the severe contamination.  A wound-VAC was planned for the dorsum of the left hand at the PIP joint of the left small finger.

Would I report 11043 and 97605 with ICD-9 682.4 and 681.00?

-North Carolina Subscriber

Answer:
The correct codes in this situation would be 11010 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and
subcutaneous tissues), 11011 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle), or 11012 (Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and...

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June 17, 2011
Hot Coding Topics

Clear The Smoke On Debridement And Active Wound Care Codes

Confused about when to choose a debridement code and an active wound code? CPT 2011 is here to your rescue with revised debridement code guidelines that clarify how to choose between the two code groups — and the key word that will tighten up your coding is depth.

“Depth is the only documentation item you need to determine the correct code,” explained Chad Rubin, MD, FACS, AMA Specialty Society Relative Value Scale Update Committee (RUC) Alternate Member with Albert E. Bothe, Jr. MD, FACS, American College of Surgeons, AMA CPT Editorial Panel Member at their joint presentation “General Surgery” at last month’s CPT Symposium in Chicago.

Active wound care, which has a 0 day global period, is for active wound care of the skin, dermis, or epidermis. For deeper wound care, use debridement codes in the appropriate location.

Example: Codes 11040 (Debridement; skin, partial thickness) and 11041 (…full thickness) have been deleted. The parenthetical note under the codes’ deletion reads, “For debridement of skin, i.e., epidermis and/or dermis only, see 97597, 97598.” The codes are revised for 2011 to reflect this change. For instance, the revision for code 11042 (Debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less) removes “Skin, and” and adds after subcutaneous tissue “includes epidermis and dermis, if performed.”

Code 97597 is revised to (Debridement [e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], open wound, [e.g., fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm], including topical application[s], wound assessment, use of a whirlpool, when performed and instruction[s] for ongoing care, per session, total wound[s] surface area; first 20 sq cm or less]).

Code 97597’s revision involves “mainly rewording to make clear how active wound care is separate from integumentary wound care,” Bothe explained.

CPT...

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December 15, 2010
Hot Coding Topics

Wound Coding: 3 Tips Help You Recover Your Full Debridement Pay

Maximize 11040-11044 pay with modifier 51.

In most cases, your practice won’t report debridement separate from wound repair codes. But when exceptions arise, follow these three tips to choose the appropriate wound repair code.

If you’re considering reporting debridement separate from a wound closure, make sure your physician’s notes clearly document that the wound was contaminated and required saline or other substances or instrumentation to cleanse and debride the wound.

Don’t miss: If you report a debridement code with your wound closure codes, append modifier 59 (Distinct procedural service) to the debridement code. This informs the payer that you recognize that debridement is generally bundled into wound repair, but that clinical circumstances required the physician to perform debridement as a separate service.

1. Look for Wound Repair With the Debridement

CPT specifies that you may also report debridement codes independently of repair codes when the physician removes large amounts of devitalized or contaminated tissue or when the physician performs debridement without immediate primary repair of a wound, notes Pamela Biffle, CPC, CPC-I, CCS-P, CHCC, CHCO, owner of PB Healthcare Consulting and Education Inc. in Watauga, Texas.

The physician may clean debris from the wound without repairing the wound because it was either not deep enough to require repair or the physician delayed the repair due to an extenuating circumstance.

In the case in which the dermatologist excises a lesion, debridement is included in the procedure. However, when the dermatologist only performs debridement or performs the debridement in addition to the wound repair, such as the case when a wound is excessively dirty or contaminated with debris, you would also code the debridement code with the wound repair/excision code, appending modifier 51 (Multiple procedures) for the multiple procedure.

Example: A patient returns to the dermatologist several days after a chemical...

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June 13, 2010
Anesthesiologist / Coding Challenge

Burn Coding: Calculate Total Body Surface Area (TBSA)

Investigate your physician’s documentation to determine the body area percentage actually debrided. Question: My anesthesiologist administered anesthesia for a burn excision on the leg of a middle-aged adult male, but he didn’t give clear notes on the patient’s affected body surface area. How do I code for this? Kansas Subscriber Answer: You will start by coding 01952 (Anesthesia [...] Related articles:

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February 17, 2010
Coding Challenge / surgery

Surgical Coding Mysteries: The Case of the Separate Mesh

Beware Separate Mesh Removal Question: The surgeon performed the following: Made 10 cm supraumbilical transverse incision with 15-blade scalpel carried down through subcutaneous tissue using Bovie. Used combination electrocautery and blunted dissection to isolate area of scar tissue on patient’s right side. Noted sutures from previous umbilical hernia repair and mesh from right-lower abdominal hernia repair. Excised [...] Related articles:

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November 21, 2009