Internal Medicine Coding Alert
Size Matters When Choosing Devitalized Tissue Removal Code
Question: A patient with a pressure ulcer on his shoulder blades reported to the office, and the internist removed devitalized tissue from the ulcer area. How should I report the service? Answers to You Be the Coder and Reader Questions were reviewed by Kathy Pride, CPC, CCS-P, director of government program services for QuadraMed in Reston, Va.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.
Minnesota Subscriber
Answer: You'll need to check the operative notes for the size of the excision area.
Option 1: If the total area removed is 20 square centimeters or less, report 97597 (Removal of devitalized tissue from wound[s], selective debridement, without anesthesia [e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may include use of a whirlpool, per session; total wound[s] surface area less than or equal to 20 square centimeters). Also, include 707.02 (Decubitus ulcer; upper back) to represent the patient's pressure ulcer.
Option 2: But if the total removal area exceeded 20 square centimeters, report 97598 (... total wound[s] surface area greater than 20 square centimeters) with 707.02 attached instead.
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