Urology Coding Alert

Question: A male patient underwent the following procedure, based on the urologist's notes: "Incision left perineum; purulent material removed, a deep dorsal 'slit' exposed glans, placed an indwelling number 14 french catheter for straight drainage, then opened entire cavity and debrided tissues extending from the perineum to the abdomen midline and up into inguinal area. Resected all tissue necrotic or infected, and at the end of the procedure used electrocautery for complete hemostasis." Can I report 10061 for the I&D and 11006 for debridement? I thought the Correct Coding Initiative (CCI) bundled those two. Also, 56405 seems an appropriate code, but that is for a female -- so should I report it?

California Subscriber

Answer: Because of the bundling issues, as you in-dicated, you will be limited as to what you can report for this procedure. You should report 11006 (Debridement of skin, subcutaneous tissue, muscle and fascia for necro-tizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure) for the debridement of the areas your urologist described, which includes the incision and drainage (I&D, 10061, ... of abscess; complicated or multiple). Then, report 54001 (Slitting of prepuce, dorsal or lateral; except newborn) for the dorsal slit with catheter placement.

Tip: Code 56405 (Incision and drainage of vulva or perineal abscess) is a female-specific code and inappropriate for you to use for a male patient.

Your primary diagnosis code should be 785.4 (Gangrene), and the secondary code should be 608.83 (Other specified disorders of male genital organs; vascular disorders for Fournier's gangrene), in that order to ensure payments for the debridement (11006). Use ICD-9 code 605 (Redundant prepuce and phimosis) for the dorsal slit procedure (54001).