General Surgery Coding Alert

Question: The surgeon debrided two sites with infected decubiti. Should I report each site separately? Which code(s) should I report for this service?


Idaho Subscriber

Answer: As a first choice, you should look to the excision of decubiti codes (15920-15999). Select a code according to the location of the ulcer(s) and whether the surgeon also performs ostectomy (bone removal) or primary suture. You may report each excision separately, and that you may also report free skin grafts (15000-15261) if the surgeon uses a graft to close the wound or donor site.

For example, the surgeon removes both a coccygeal pressure ulcer and a sacral pressure ulcer with ostectomy. Report 15920 (Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture) and 15935 (Excision, sacral pressure ulcer, with skin flap closure; with ostectomy). In addition, the surgeon uses a full-thickness graft to close the sacral pressure ulcer excision. Therefore, you may report, for instance, 15200 (Full-thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less).

If you don't think the surgeon's documentation will support a code from the 15920-15999 range, you could select 11000 (Debridement of extensive eczematous or infected skin; up to 10% of body surface).

In this case, you cannot code the sites separately because 11000's descriptor specifies a certain percentage of body surface. Rather, you should add the total surface area of the two sites together to get the appropriate percentage. Based on that total area, you can report +11001 (... each additional 10% of the body surface [list separately in addition to code for primary procedure]) if the physician debrides a total area greater than 10 percent.

If the infected decubiti extend deeper than the skin or if debridement involves more than just skin, you might also report a code from the 11040-11044 series (Debridement; skin, partial/full thickness, subcutaneous tissue, muscle and bone).