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The Centers for Medicare & Medicaid Services (CMS) defines a debridement as “the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound (CMS.gov, 2014). Debridement may include the following: skin, subcutaneous tissue, fascia, muscle, bone and the removal of foreign material (CMS.gov, 2014).
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The topic of debridement has always been a sore spot with coders. Typically, you were told that if a sharp instrument was used then you coded it as an excisional debridement and if not then a non-excisional debridement should be coded in ICD-9 PCS. Can you be any vaguer? There is so much more information needed today to ensure that a debridement is coded accurately and considered medically necessary. The Centers for Medicare & Medicaid Services (CMS) defines a debridement as “the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound (CMS.gov, 2014). Debridement may include the following: skin, subcutaneous tissue, fascia, muscle, bone and the removal of foreign material (CMS.gov, 2014). They are typically performed on wounds, burns, pedicle or flap graft, and open fractures.
In the world of ICD PCS, a debridement can be either excisional or non-excisional and can be performed on various parts of the body including nail, nail bed, nail fold, and open fractures. Whatever the type of debridement performed; the purpose should be to promote healing. CMS states that, “if there is no necrotic, devitalized, fibrotic, or other tissue or foreign matter present that would interfere with wound healing; the debridement service is not medically necessary. This, of course, would prompt a denial in claim reimbursement. The coder is to consider if the procedures for “active wound care management” is taking place rather than a debridement. Active wound care management procedures involves removal of devitalized tissue from wound(s); non-selective debridement without anesthesia (e.g., wet-to-moist dressings, enzymatic abrasion) including topical application(s), wound assessment, and instruction(s) for ongoing care (CMS.gov, 2014). Below is an image of the debridement of necrotizing fasciitis.
DEBRIDEMENT
WHAT TO EXPECT
1 Debridement?
2 Types of Debridement?
3 ICD-9 PCS & ICD-10 PCS
Coding & Guidelines
4 Requests for Coding Topics
“The purpose of
debridement is to
promote healing.”
September 2014
Volume 1 Issue 9
By Cynthia Brown, MBA, RHIT, CCS
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CCHIS, P.O. Box 3019, Decatur, GA 30031 404-992-8984 http://www.cyntcodinghealth infor mationserv ices.com Cynth ia@cyntcodinghealthinformat ionserv ices.com [phone ]
CODING YESTERDAY’S NOMENCLATURE TODAY®
Coding Debridement in ICD-9 PCS & ICD-10 PCS
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Page 2 Coding Yesterday’s Nomenclature Today
Without further confusing the coder with excisional, selective, or non-selective debridement which would have to be determined when assigning the correct CPT codes; the coders should become familiar with the different types of debridement and their code assignment in ICD PCS. Some of the more common procedures include:
Autolytic debridement involves the use of the body’s own enzymes and moisture to re-hydrate, soften and liquefy the targeted area. This method is selective AND would be considered non-excisional.
Enzymatic debridement is usually performed on wounds with large amount of necrotic debris or eschar formation. This procedure can be selective or non-selective AND would be considered non-excisional.
Mechanical debridement is when the dressing is allowed to go from moist to dry and then removing the dressing resulting in a non-selective form of debridement AND would be considered non-excisional.
Surgical debridement uses a sharp instrument or laser to quickly remove large amounts of necrotic and infected tissue. It is typically performed under some type of anesthesia in the operating room, ER or at bedside and is selective AND would be considered excisional.
Maggot therapy is the use of small numbers of maggots to consume the necrotic tissue and is typically more precise than would be a surgical procedure AND would be considered non-excisional.
MAGGOT THERAPY
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“Surgical Debridement”
“One of the common
debridement
procedures is
surgical.”
Types of Debridement
Coding Yesterday’s Nomenclature Today
ICD-9 PCS and ICD-10 PCS CODING &GUIDELINES
Codes for Debridement
ICD-9 PCS 86.22 Excisional Debridement of Wound, Infection, or Burn. Removal by excision of: Devitalized tissue, necrosis, and slough. Excludes: Debridement of abdominal wall (wound) (54.4); bone (77.60-77.69); muscle (83.45)/muscle hand (82.36); nail (bed) (fold) (86.27); Non excisional debridement of wound, infection, or burn (86.28); open fracture site (79.60-79.69); pedicle flap or flap graft (86.75).
ICD-10 PCS, the coder would have to go to the Medical & Surgical Section (0); the appropriate Body System (H or J); Operation (Excision); locate the appropriate Body Part; appropriate Approach; Device (Z); and Qualifier (Z).
ICD-9 PCS 86.27 Debridement of Nail, Nail Bed, or Nail Fold. Removal of: Necrosis and Slough. Excludes: Removal of Nail, Nail Bed, or Nail Fold (86.23).
ICD-10 PCS, the coder would have to go to the Medical & Surgical Section (0); the appropriate Body System (H); Operation (Excision) (B); and then locate the appropriate Body Part (Q or R); Approach (X); Device (Z); and Qualifier (Z).
ICD-9 PCS 86.28 Non excisional Debridement of Wound, Infection, or Burn. Debridement NOS; Maggot Therapy; Removal of Devitalized Tissue, Necrosis, and Slough by such Methods as: brushing, irrigation, (under pressure), scrubbing, washing; Ultrasonic Debridement; Water Scalpel Jet.
ICD-10 PCS, the coder would have to go to the Medical & Surgical Section (0); the appropriate Body System (H or J); Operation (Extraction)(D); and then locate the appropriate Body Part; Approach (3); Device (Z); and Qualifier (Z). Note: Non excisional debridement is coded to EXTRACTION in ICD-10 PCS.
Note: In ICD-9 PCS and ICD-10 PCS the DEEPEST level of the debridement should be coded. For example, if skin, subcutaneous tissue, and muscle are debrided; then the coder should code down to the muscle (83.45 and 82.36 for muscle in hand in ICD-9 PCS and 0KB and 0ZZ in ICD-10 PCS. Debridement of bone in ICD-9 PCS includes codes 77.60-77.69 and 79.60-79.69 for compound fractures in ICD-9 PCS and 0PB & 0QB for Medical & Surgical Section; Body System; and Operation and 0ZZ for Approach, Device, and Qualifier in ICD-10 PCS.
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