Urology Coding Alert

Question: On the inferior aspect of the scrotum and midline, there was roughly a 4.5 x 3 cm area of necrotic skin tissue. My urologist debrided this at bedside today after the patient received some pain medication. It appears to be two separate pockets that he suspected had abscess fluid in them, spontaneously decompressed. The dependent portion for the necrosis made it possible that the patient may have had some padding or some other device in his diaper because of the appearance of the ischemic necrosis. There was no palpable crepitus. The wound defects were packed with Dakin-soaked gauze. After talking to my urologist, I coded this as 11043 (Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less) with diagnosis code N49.2 (Inflammatory disorders of scrotum) for scrotal cellulitis. However, my claim was denied for medical necessity. Is there a different diagnosis that I could use for this code?

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Answer: Codes 11042 (Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less)) and 11043 are used most often for orthopedic debridements and may not include the genitalia. Your case sounds more like Fournier gangrene. You should report N49.3 (Fournier gangrene). You should also report 11004 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum) instead. Your CPT^® code and ICD-10 diagnosis seem inappropriate in this case.