Urology Coding Alert

Question: The patient was diagnosed with Fournier’s gangrene wounds. Following the signing of the informed consent, the patient was taken to the operating room, where general anesthesia was administered. The patient was positioned in dorsal lithotomy, the wound vacuum assisted closure (VAC) was taken off, and standard sterile preparation and draping were carried out. A timeout procedure was also conducted. The dimensions of the wound were 12x7 cm, and upon examination, signs of necrotic tissue were observed; however, there was some healthy granulation tissue exhibited. The operation commenced with thorough washing of the wound using antibiotic solution. The necrotizing tissue was removed from the external genitalia and perineum. After removal of tissue, a Penrose drain was positioned 2 cm above the wound’s upper boundary and was laid in the wound bed. The drain was fastened using 2-0 Vicryl sutures applied in a discontinuous manner for the deeper layers. Subsequently, 2-0 nylon sutures were used to bring the skin back together, employing a mix of horizontal mattress and separate sutures. Some sections of the skin required removal to get better alignment of the skin’s edges. The wound was gently closed to avoid strain and to ensure any potential fluid accumulation or infection could be drained correctly. Which code(s) should I report for this?

Florida Subscriber

Answer: According to Stephanie Stinchcomb Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime coder and consultant in Glen Burnie, Maryland, the treatment codes for Fournier’s gangrene include 11004 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum), 11005 (… abdominal wall, with or without fascial closure) and 11006 (… external genitalia, perineum and abdominal wall, with or without fascial closure). The correct code is based on the amount and location of the tissue removed. This should be well documented in the operative report. If implantation of absorbable mesh or other prosthesis is performed, code 15778 (Implantation of absorbable mesh or other prosthesis for delayed closure of defect(s) (ie, external genitalia, perineum, abdominal wall) due to soft tissue infection or trauma) should be reported as well. Closure of the fascia is included in the procedure so this cannot be reported separately.

These procedures have 0-day global periods. Therefore, the above codes do not require any modifiers, even when billed during the postoperative period.