# excisional debridement



## Lujanwj (Nov 16, 2011)

Are we talking about 11000 (97597/8) series?  If so, excision is just that - "The act of cutting away or taking out" (Tabers).  CPT doesn't state what tool is used to do the excision.  If you look at the example (e.g.) in 97597 is says "high pressure water jet".  The water jet "takes out". I would be more concerned about the depth of the tissue "excised" rather than the tool or method of the excision.  

Remember, CPT rarely limits codes to the tools used but rather what is being done.  For example Tonsillectomy - you could excise it with a blade or laser but in the end it's still just a tonsillectomy


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## Lujanwj (Nov 16, 2011)

I think you are missing the point of the article.  Yes, it's about debridement but It's really about having good documentation/Operative Notes.  These rules would/could apply to any operative note.  

The article is really Vickie Balistreri opinion.  In my opinion, there isn't such a thing as nonexcision debridement.  I can't find a definition in any of my medical dictionaries; however, excision is and it's exactly what they are defining as nonexcision.  

CPT language is vague, because there are so many different tools and methods out there to do the different procedures.  The only way to really know what a code entails and is a legitimate source you must get it from the AMA.  CPT Changes: An insiders view, Priciples of CPT coding, and CPT Assistant are great resources.  Anything else is someone interpretation of the codes.  To prove my point, CPT Assists 05/11 p.3 Coding tip: 

Question: Would muscle debridement utilizing Versajet be coded with active wound care management codes, 97597-97598 or the debridement codes, (eg, 11043)?

AMA's Answer: The wound depth debrided determines the appropriate code. If just the biofilm on the surface of a muscular ulceration is debrided, then codes 97597-97598 would be appropriate. But if muscle substance was debrided, the 11043-11046 series would be appropriate, depending on the area debrided.  **This is a contradiction of the article which says " Examples of nonexcisional debridement are pulsed lavage, mechanical lavage, mechanical irrigation, high-pressure irrigation, etc. For instance, VersajetTM debridement is always considered nonsurgical, mechanical debridement because it does not involve cutting away..."

Good luck!


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## Lujanwj (Nov 16, 2011)

Exactly, it's about documentation.  Those elements should be document in all OpNotes regardless of debridement, appi, fracture repair, etc...  You can't just say I did a colectomy and not describe it in the body of the OpNote. 

In any event, I have no idea what you are getting at.

Good luck!


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