# Debridement of anal fissure



## codedog (Oct 15, 2009)

Anyone know the procedure code for a debridement of an anal fissure ?


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## jgf-CPC (Oct 15, 2009)

CPT/HCPCS Codes back to top 
Italicized and/or quoted material is excerpted from the American Medical Association, Current Procedural Terminology (CPT) codes.

11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE 
11001 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY SURFACE, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 
11040 DEBRIDEMENT; SKIN, PARTIAL THICKNESS 
11041 DEBRIDEMENT; SKIN, FULL THICKNESS 
11042 DEBRIDEMENT; SKIN, AND SUBCUTANEOUS TISSUE 
11043 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, AND MUSCLE 
11044 DEBRIDEMENT; SKIN, SUBCUTANEOUS TISSUE, MUSCLE, AND BONE 
29580 STRAPPING; UNNA BOOT 
97022 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; WHIRLPOOL 
97597 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), WITH OR WITHOUT TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, MAY INCLUDE USE OF A WHIRLPOOL, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 20 SQUARE CENTIMETERS 
97598 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, HIGH PRESSURE WATERJET WITH/WITHOUT SUCTION, SHARP SELECTIVE DEBRIDEMENT WITH SCISSORS, SCALPEL AND FORCEPS), WITH OR WITHOUT TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, MAY INCLUDE USE OF A WHIRLPOOL, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 20 SQUARE CENTIMETERS 
97602 REMOVAL OF DEVITALIZED TISSUE FROM WOUND(S), NON-SELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA (EG, WET-TO-MOIST DRESSINGS, ENZYMATIC, ABRASION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION 
97605 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS 
97606 NEGATIVE PRESSURE WOUND THERAPY (EG, VACUUM ASSISTED DRAINAGE COLLECTION), INCLUDING TOPICAL APPLICATION(S), WOUND ASSESSMENT, AND INSTRUCTION(S) FOR ONGOING CARE, PER SESSION; TOTAL WOUND(S) SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS 

ICD:
565.0 - 565.1 ANAL FISSURE - ANAL FISTULA 
566 ABSCESS OF ANAL AND RECTAL REGIONS


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## ASC CODER (Oct 16, 2009)

Debridement is the process of removing dead tissue or eschar, debris or foreign material from infected skin or wound to promote healing and to control infection. There are several methods in which this may be accomplished. One method is excisional debridement where contaminated, infected and/or dead tissue may be cut out or the surgical removal from a structure or an organ part. Another method is non-excisional or mechanical debridement (BRUSHING, scrubbing, WASHING) when the affected area is debrided by flooding it with an abundant amount of saline solution to wash away debris and other contaminants. This saline irrigation should not be confused with the surgical debridement of a wound, burn or other defect, nor is it billed separately. Debridement is a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure. To report â€œexcisional debridementâ€� of the skin the physician's documentation should reflect the type of debridement (excisional or nonexcisional), but does not necessarily need to document that â€œhealthy/viable tissue was encounteredâ€�. For example; •ICD-9CM code 86.22 -Excisional debridement of wound, infection or burn; devitalized tissue, slough, necrosis •ICD9-CM code 86.28 -Non-excisional debridement of wound, infection or burn; maggot therapy, removal of devitalized tissue, necrosis and slough by such methods as: BRUSHING, irrigation (under pressure) scrubbing WASHING or water scalpel (jet). According to the AHA Coding Clinic for ICD-9-CM Volume 25, 1st Quarter 2008, the code assignment for debridement is based upon the provider's documentation. Clear and concise documentation is required in order to accurately report â€œexcisionalâ€� debridement. The documentation should be very specific regarding the type of debridement. The use of sharp instruments does not always indicate that an â€œexcisionalâ€� debridement was performed. If the documentation is not clear the provider should be queried for clarification.  

It is my understanding that the primary distinguishing factor between excisional debridement and nonexcisional debridement is that excisional debridement is the surgical removal of necrotic/devitalized tissue. If the surgeon documents that he/she excised devitalized tissue, do best practices require that the surgeon also document that he/she reached healthy viable tissue or that he/she excised all necrotic or devitalized tissue (in toto)? 

Also, for nonexcisional debridement, do best practices indicate that the surgeon should document that he/she performed a nonexcisional debridement until healthy/viable tissue was encountered?  
question posted in codecorrect coach.


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