Cardiology Coding Alert

Question: The cardiologist performed a pacemaker extraction. He initially replaced a wound vacuum-assisted closure (VAC) sponge. Since the VAC was oversized, it was difficult to remove, and the cardiologist removed some of the muscle. The wound started to bleed and continuously ooze, so the cardiologist went in for an exploration. According to his medical documentation, the muscle bed, especially in regions where he debrided, were necrotic-looking. The pseudocapsule was oozing, and he tried to perform electrocautery, but it was not successful. He then used Surgicel© on the bleeding points and applied direct pressure for 15 minutes. Finally, the cardiologist placed sutures in the muscle bed and packed the wound with iodoform. The patient’s labs came back negative for bacterial growth. I think I should report 20101 for the wound exploration, but I am not sure if I can bill for a wound the cardiologist caused? Then, I was thinking I could report 10180, but if that labs came back negative, I’m not sure if that’s the correct code either. Can you help please me?

South Carolina Subscriber

Answer: “I would report debridement procedure(s) codes 11400 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less)-11406 (Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm) based upon medical necessity and specifics of diameter, which means the physician will need to provide an addendum and provide the diameter of debridement that was performed,” says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

The physician did not appear to reapply a wound VAC, but did packing at this time. He is addressing essentially the original issue that led to the wound VAC being placed, presumably due to infection, which was negative according to the pathology results.

The physician did not cause the wound, but in the process of addressing the large VAC and sponge removal, he had to adjust the size of the area by removing muscle and then performed debridement and dealt with the associated bleeding, Neighbors says.

These type of procedures stay open until resolved or the physician feels it is healed enough to close, Neighbors adds. “I would not report anything to capture for the initial sponge removal and or VAC change as it would be inclusive to the ultimate debridement as would the control of bleeding from the debridement procedure.”

CPT^® Assistant Vol. 26, No. 2, addresses when it would be appropriate to report surgical debridement CPT^® codes with codes for negative pressure wound therapy (eg, vacuum assisted drainage collection):

“Negative pressure wound therapy (NPWT) places mechanical stress on the tissue that may increase the rate of cellular proliferation, granular tissue formation, and new vessel growth. NPWT is not considered a component of the surgical debridement codes… Therefore, codes 97605, Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), 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, and 97606, Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters, may be reported in addition to the debridement procedure, if performed.”

Remember: There are risks to every surgical procedure and each case should be coded accordingly on a case by case basis, Neighbors cautions. “I personally would not hold the physician accountable for these complications.”

Note: It’s extremely difficult to provide a 100 percent recommendation without reading the patient’s entire medical record, so always do your research before reporting a debridement(s) procedure codes, Neighbors adds.