# Coccygectomy with excision of sacral pressure ulcer?



## sweetybird0472 (May 23, 2011)

I have a scenario with a coccygectomy and excision of sacral pressure ulcer  it is stated that they area was packed with a damp dressing rather than sutured.

I have a group class mate that is wanting to use 27080 and 15933  .   I do not think you can do this for a few reasons:


it states with primary suture, however the procedure description states that it was packed with a damp dressing and mentions nothing of using sutures.
The code 27080 is for the excision of the coccyx,  so it would not be necessary to use another code describing bone removal (ostectomy)

Could these codes be used for this?  If not, would only 27080 cover the excision of the coccyx as well as the excision of the sacral pressure ulcer?

Thanks


----------



## dadhich.girish (May 23, 2011)

Please check this set of codes:  27080, 15931-52.  Mod 52 is placed for reduced service of not repairing the wound with sutures and leaving it to heal by secondary intention.


----------



## CRC CPC (May 31, 2011)

sweetybird0472 said:


> I have a scenario with a coccygectomy and excision of sacral pressure ulcer  it is stated that they area was packed with a damp dressing rather than sutured.
> 
> I have a group class mate that is wanting to use 27080 and 15933  .   I do not think you can do this for a few reasons:
> 
> ...



I would think that the ostectomy 15933-52 (not sutured) is included and I personally would not use 27080... The 15933 is for excision and removal of the bone.  Per coding companion.  I would use 15933-52


----------



## preserene (May 31, 2011)

Anatomically, sacral segments are different entity from coccyx though thEY are all fused together as one piece.
So, you have to report them separately.
*27080*- for coccygectomy.
*15931* for excision sacral pressure ulcer, 15933 for excision of the pressure ulcer plus excision of the sacral bony tissues involved in the pressure ulcer. 
If you go into the *pathophysiology *of pressure ulcers, there are 4 STAGES OF PRESSURE ULCERS CLASSIFIED: 

*STAGE III *- INVOVLES FULL THICKNESS LOSS OF THE SKIN BUT NOT THROUGH THE FASCIA.
*STAGE IV *- THE ABOVE PLUS COULD INVOLVE FASCIA , AND THE UNDERLYING BONE, CAUSING EXTENSIVE DESTRUCTION AND NECROSIS, REQUIRING DEEP SURGICAL DEBRIDMENT , NECESSITATING REMOVAL OF SOME OR MORE PARTS OF THE OSTEUM(BONE TISSUE ) ie, *OSTECTOMY OF THAT PARTICULAR PART OR SEGMENT OF THE INVOLVED BONYTISSUE*.

 What I am trying  to say is : the "Coccygectomy" 27080 does not bundle the excision of the pressure ulcer(15931), nor the excision of pressure ulcer with "ostectomy"15931. So this ostectomy is not the same as coccegectomy.


----------



## sweetybird0472 (May 31, 2011)

preserene said:


> Anatomically, sacral segments are different entity from coccyx though thEY are all fused together as one piece.
> So, you have to report them separately.
> *27080*- for coccygectomy.
> *15931* for excision sacral pressure ulcer, 15933 for excision of the pressure ulcer plus excision of the sacral bony tissues involved in the pressure ulcer.
> ...



Preserene,

Thank you.  This is how my coding instructor explained this to me as well,  however for the scenario we were presented with it did not state what stage the ulcer was at.  I used the unspecified code and it was correct.  Here is the actual procedure note.

*PREOPERATIVE DX:*Sacral pressure ulcer, osteomyelitis of the coccyx.

*POSTOPERATIVE DX:*Sacral pressure ulcer, osteomyelitis of the coccyx.

*NAME OF PROCEDURE:*Coccygectomy, debridement and irrigation of sacrum, with sacral bone biopsy, excision of pressure ulcer.

*ANESTHESIA:*General

*PROCEDURE DESCRIPTION:*Anesthesia was administered and the patient was then prepped and draped.  The sacral pressure ulcer was excised widely.  The coccyx was then removed.  Half was sent to Pathology and half was sent to the Lab for culture.  The sacrum was then debrided & a Bx obtained.  Again, half was sent to Lab for culture and half was sent for eval of osteomyelitis.  The wound was then irrigated with a pulse lavage using antibiotic solution.  The area was packed w/ a damp dressing.


----------



## preserene (Jun 1, 2011)

Debridement of the Sacrum itself means it is stage 4 (bone debridement) and excision is done .So the CPTcode to be reported 15933. ie  with ostectomy.

[please correct my typing mistake of 15931for with ostectomy. I should have typed it as 15933].
Even if the stage was not written by your doctor , in the operation report it is clear that there was bone involvement and debridement of bone is done.

So your case merits for 15933 and not 15931, along with 27080


----------



## sweetybird0472 (Jun 1, 2011)

Thank you so much!


----------

