Recently we have had a several instances when a patient will undergo debridement that falls into the category of 11042-11047, with the diagnosis of a necrotic abscess, either from advanced cellulitis, hematoma, etc. These aren't payable under medicare LCD's. Is it appropriate to code a complicated open wound, even if the wound wasn't necessarily traumatic?
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Wiki Debridement Dx
- Thread starter molisa
- Start date
hewitt
Expert
Sorry, but I think this is too general a question. What CPT and ICD-9 combos are you using? Can you provide a "real life" example? Yes, an encounter must include a CPT and ICD-9 for payment, even if the wound wasn't necessarily traumatic. Is there an underlying condition that caused the abscess? What else is going on? 
The op note reads:
The patient had developed an ischemic necrosis from a hematoma of the left lower leg. This area had been previously drained and debrided 3 days ago. Marginal necrotic tissue had now progressed to a full eschar. The total size of the lesion is approximately 10 x 14 cm. The lateral margins of further necrosis were sharply excised. The necrotic eschar was sharply excised. The underlying subcutaneous tissue and muscle fascia was also copiously irrigated with saline solution. There was no evidence of acute infection or abscess present. Hematoma debris from deep within the wound was also further irrigated and released.
CPT's billed were 11042 and 11045; ICD's of 709.8, 924.10. They were denied due to diagnoses. I'm wondering if it would be appropriate to use 891.0 with these two codes.
The patient had developed an ischemic necrosis from a hematoma of the left lower leg. This area had been previously drained and debrided 3 days ago. Marginal necrotic tissue had now progressed to a full eschar. The total size of the lesion is approximately 10 x 14 cm. The lateral margins of further necrosis were sharply excised. The necrotic eschar was sharply excised. The underlying subcutaneous tissue and muscle fascia was also copiously irrigated with saline solution. There was no evidence of acute infection or abscess present. Hematoma debris from deep within the wound was also further irrigated and released.
CPT's billed were 11042 and 11045; ICD's of 709.8, 924.10. They were denied due to diagnoses. I'm wondering if it would be appropriate to use 891.0 with these two codes.
mitchellde
True Blue
If the hematoma were late effects of an injury and the necrosis then due to the hematoma would this be better represented then with a code for a post traumatic wound infection code followed by a late effect of injury code?
It would help to know what the hematoma is caused by.
But to answer your question the 891.0 does not look correct with what you have posted, neiher do the other codes you listed look correct. More information is still required to address this issue.
It would help to know what the hematoma is caused by.
But to answer your question the 891.0 does not look correct with what you have posted, neiher do the other codes you listed look correct. More information is still required to address this issue.
hewitt
Expert
I agree, more information is needed. So far it sounds more like an ulcer, 707.10. You state above that "The underlying subcutaneous tissue and muscle fascia was also copiously irrigated with saline solution." Had this progressed down to muscle?
Thanks for feeling my pain - that was all I got from the surgeon. Tore through hospital notes to find that the patient hit his lower leg on something, got a hematoma which then enlarged and progressed to a cellulitis according to primary care. The area was I&D'd to evacuate the clot and then debrided two days later as stated in this op note.