General Surgery Coding Alert

Closure with muscle flaps provides an additional reimbursement opportunity Knowing wound depth and the closure method is crucial to choosing a correct code for decubitus ulcer treatment. Get the facts here, and avoid selecting a debridement code when a better-paying excision may apply. Closure Helps Identify Excision If the physician closes the wound following treatment of a decubitus ulcer (also known as bedsores, pressure sores or pressure ulcers), you should report an excision code (15920-15958). Knowing this simple fact alone is all you-ll usually need to know to differentiate excisions from debridements (11040-11044). Only if there are no signs of infection will the surgeon perform an excision and close the wound. Documentation of remaining infection (the surgeon will leave the wound open) should provide a clue that a debridement code is a better match than an excision code, says Kate Kibat, CPC, compliance educator at the University of Washington Physicians in Seattle. Location Narrows Excision Code Selection You should select an appropriate excision code according to the treated ulcer's location: - Coccygeal -- 15920-15922 - Sacral -- 15931-15937 - Ischial -- 15940-15946 - Trochanteric -- 15950-15958 - All other (unlisted) locations -- 15999, Unlisted procedure, excision pressure ulcer. After you have narrowed your selection according to ulcer location, you must determine whether the operative note describes ostectomy at the excision site. Surgeons will perform ostectomy (removal of underlying bony structure) when the bone under the ulcer also becomes infected, says Stacey Radick, RHIT, CCS, of Opticode. "The main indication you-re likely to see for ostectomy would be a diagnosis of pressure ulcer with osteomyelitis," Radick says. A quick glance of the CPT code descriptors will reveal which codes include ostectomy. For instance, 15931 describes "excision of a sacral pressure ulcer with primary suture," while 15933 describes the same procedure but also "with ostectomy" to account for further bone removal below the ulcer site. Closure Type Also Matters for Excision You must determine the precise type of closure the surgeon uses following ulcer excision, Radick says. Closure types include primary suture (e.g., 15920, Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture), skin flap (e.g., 15934, Excision, sacral pressure ulcer, with skin flap closure), and separate muscle/myocutaneous flap or skin graft (e.g., 15956, Excision, throchanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure). Report muscle/skin grafts separately: Per CPT guidelines, when the surgeon closes a sacral, ischial or trochanteric ulcer excision using muscle flaps or skin grafts, you should report a separate code to describe the closure, Radick says. "These procedures can be done either at the same time or as a staged procedure," Radick says. For staged repairs that occur during the excision's global period, [...]