Home Health ICD-9/ICD-10 Alert

Published on Thu Jan 21, 2010 PDF

Question: We have a patient who was admitted to service following a revision of a pedicle or flap graft (procedure code 86.75). At recertification, this wound is being called a dehisced surgical wound as it was at start of care. Prior to the first flap procedure, the wound was originally a pressure ulcer. The depth is 2 cm and the wound bed is 50/50 granulation/hard black eschar. Wound length is 7cm, width 2cm. Does this remain a dehisced surgical wound or is it now a pressure ulcer since the flap procedure has failed?

Answer: OASIS C guidance indicates that this wound is no longer a pressure ulcer once a flap procedure has been performed. It is a surgical wound. If the current wound began with dehiscence of the flap, it is still a dehisced wound. If the flap had healed and subsequently broken down, it would be a pressure ulcer.

This scenario brings to light an unanswered dilemma. The coding guidelines indicate that you should code for a pressure ulcer with a muscle flap as an unstageable pressure ulcer with a code from the 707.0x (Pressure ulcer) series, reporting the appropriate location in the fifth digit. You would follow this with 707.25 (Pressure ulcer, unstageable). But in your situation, you also have a dehisced surgical wound. In the absence of any official guidance on the matter, report the dehisced surgical wound with 998.32 (Disruption of external operation [surgical] wound) and then follow the code with a list of pressure ulcer codes.

Remember, even if you could see down to the patient's bone through this wound, you're not coding for an open wound. That's an incorrect assumption in ICD-9 coding.

Open wounds are actually trauma wounds. If the wound wasn't created as a result of trauma such as a laceration, puncture wound, cut, avulsion, or animal bite, it's not appropriate to list a code from the 870.x-897.x (Open wounds) categories.

Alternately: Complicated surgical wounds occur when a surgical wound isn't healing as expected. Something has caused the surgical wound to become complicated. Non-healing, infected, and postoperative fistulas are all examples of complicated surgical wounds.