General Surgery Coding Alert

 Distinguish physician work from other providers’.

When your general surgeon treats a patient for a pressure ulcer, a lot of choices will confront you as you try to narrow down the diagnosis and procedure coding.

Look at the following case, then let our experts guide you through the steps to select the most accurate codes to represent both your surgeon’s work and the patient’s medical condition:

Example: A 54- year-old male patient presents with a pressure ulcer, or pressure injury, of the left heel measuring 26 sq cm. The surgeon notes tissue loss down to the bone with a necrotic wound and developing gangrene. The surgeon uses forceps, scissors, and scalpel to remove dead or infected tissue to clean and debride the pressure injury. The surgeon dresses and bandages the wound and instructs the patient to keep off the foot, keep the ulcer clean and dressed, and follow up in one week.

Zero In on Procedure Code

To accurately report the surgeon’s work in this case, turn to the wound debridement codes 11042-+11047 (Debridement…). “These codes are based on depth of the ulcer, not anatomic site,” explains Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, product manager, MRO, in Philadelphia.

In this case, you’ll choose 11044 (Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less) for the initial 20 sq cm and +11047 (… each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)) for the additional 6 sq cm the surgeon documents.

Because the surgeon documents tissue loss down to the bone, you shouldn’t select one of the other debridement codes for wounds no deeper than subcutaneous tissue (11042/+11045, Debridement, subcutaneous tissue (includes epidermis and dermis, if performed) …) or wounds no deeper than the fascia (11043/+11046, Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed) …).

“Wound-debridement codes 11044-+11047 all involve deeper layers,” according to Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington.

Add-up: Because these codes are based on depth, not anatomic location, you should use just one code (plus associated add on, if appropriate) per depth per day. That’s true even if the surgeon debrides multiple wounds of the same depth at different sites. In fact, “Practices are seeing denials due to overbilling of the codes at the same depth,” cautions Jennifer McNamara CPC, CCS, CPMA, CRC, CGSC, COPC, AAPC Approved Instructor, director of education and coding at OncoSpark in Southpark, Texas.

Avoid these: Coders might be tempted to turn to other debridement codes in this case, such as 97597/+97598 (Debridement … for ongoing care …) or even 97602 (Removal of devitalized tissue from wound(s) … for ongoing care …). But those codes aren’t correct for this scenario. As the descriptors tell you, these codes are not for an initial wound debridement encounter. Instead, the codes describe subsequent active wound care management, and the work is often carried out by non-physician practitioners.

Different: The surgeon’s work in this case also doesn’t meet the criteria for other wound therapy services described by 97605/97606 (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 …).

Follow Clues for Correct Diagnosis

Before you dig into the L89.- (Pressure ulcer) codes, you will need to pay attention to the Code first note that accompanies the group. There, you’ll find the instruction to sequence I96 (Gangrene, not elsewhere classified) before documenting the specified pressure ulcer.

Site: Because pressure ulcer codes are broken down first by site, determining the first four characters of the diagnosis code is relatively straightforward. The provider’s notes indicate the pressure ulcer is on the patient’s heel, so you’ll look to the L89.6- (Pressure ulcer of heel) codes to begin narrowing down your code options.