General Surgery Coding Alert

Question: The surgeon treated a patient with decubitus ulcers on his right hip and buttock. The physician debrides partial skin from the right hip, and skin and subcutaneous tissue from the buttock. How should we report this encounter, and should there be more than one ICD-9 code?

Michigan Subscriber

Answer: This encounter should include a pair of ICD-9 codes: one for each debridement. Since 2004's installment of ICD-9, the diagnosis codes for decubitus ulcers have included a fifth-digit classification that describes the wound's location.
 
On the claim, you should:
 
- report 11042 (Debridement; skin, and subcutaneous tissue) for the buttock debridement.
 
- attach ICD-9 code 707.05 (Decubitus ulcer; buttock) to 11042 to show the ulcer's location.
 
- report 11040 (... skin, partial thickness) for the hip debridement.
 
- attach 707.04 (Decubitus ulcer; hip) to 11040 to show the location of the ulcer.

ICD-9 also includes decubitus ulcer codes for:
 
- unspecified site (707.00)
 
- elbow (707.01)
 
- upper back (707.02)
 
- lower back (707.03)
 
- ankle (707.06)
 
- heel (707.07)
 
- other site (707.09).