General Surgery Coding Alert

Muscle flaps and skin grafts for closure can be separate When reporting treatment for a decubitus ulcer (also called a pressure ulcer or bedsore), you should know the method of closure (if any), as well as the location and depth of the wound. With this information, choosing the correct code is easy. Consider Closure First If the physician closes the wound, you can be certain that she performed an excision (15920-15958), says Tray Dunaway, MD, FACS, CSP, CHCO, CHCC, a surgeon, speaker, physician and coding educator, and healthcare consultant in Camden, S.C. In this case, the surgeon will clear the wound of all infection before closing. Additionally, underlying bony structures (such as a portion of the sacrum) may become infected as a result of the pressure ulcer, and the surgeon may remove these structures at the same time as the pressure ulcer excision in a procedure called an ostectomy. The surgeon may also perform ostectomy when the ulcer won't heal and excision of the underlying bone will keep the wound from rubbing. CPT provides dedicated codes to report pressure ulcer excision with ostectomy. Finally, CPT distinguishes between the types of closure, which can include primary suture, skin flap closure, and muscle/myocutaneous flap or skin graft closure. Consequently, you will choose an appropriate excision code according to the ulcer's location, whether the procedure includes ostectomy and the type of closure, as illustrated in the charts on page 87. Note: For pressure ulcer excision in an unlisted location, you must choose 15999 (Unlisted procedure, excision pressure ulcer). Be sure to include full documentation describing the ulcer's location, whether excision included ostectomy and the type of closure (primary suture, skin flap, muscle flap, skin graft, etc.) the surgeon used. You Can Report Muscle/Skin Grafts Separately 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, according to CPT guidelines. For example, the surgeon excises an ischial pressure ulcer with ostectomy. She then closes the operative wound using muscle flap. To report the excision, you should use 15946 (Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closure). Per CPT instructions, you may report the muscle flap closure separately using 15734 (Muscle, myocutaneous, or fasciocutaneous flap; trunk). Specifically, you can report muscle/skin graft codes in addition to excision codes 15936-15937, 15946, 15956 and 15958. Select Debridement Codes by Depth If the surgeon leaves the wound open, you will report a debridement (11040-11044) rather than an excision. The surgeon may choose to leave the wound open in anticipation that healthy tissue will grow over the ulcer site. This method may require [...]