Urology Coding Alert

Question: What is the correct diagnosis code for Fourniers gangrene? How should we code the treatment?

Illinois Subscriber

Answer: There are different diagnosis codes that could be used for Fourniers gangrene, an infective gangrene of the scrotum, including 785.4 (gangrene), 608.83 (other specified disorders of male genital organs; vascular disorders) or 608.4 (other inflammatory disorders of male genital organs). All three could be used. Code 608.83 applies to hematoma, hemorrhage or thrombosis of the seminal vesicle, spermatic cord, testis, scrotum, tunica vaginalis, or vas deferens; 608.84 applies to distention of the membrane covering the testis and epididymis due to infusion of lymphatic fluids. Urologists can code procedures used to treat the patient with 11041-11044 (debridement) depending on the extent and the depth of the surgery done. The most likely code to use is 11043 (debridement; skin, subcutaneous tissue, and muscle).

Because 11043 has a 10-day global period, use modifier -58 (staged or related procedure or service by the same physician during the postoperative period) on any second surgical code, such as a repeat debridement performed during the 10-day global. If the dissection is extensive and takes an inordinate amount of time and effort, append modifier -22 (unusual procedural services).