Wiki Debridement of Tracheostomy

[nauger]

I need help coding for a Debridement of Tracheostomy. I've been using 11042 because I cannot find a code specific for the tracheostomy, but Medicare is now giving me not medically necessary denials. I've been using diagnosis 51901 (infection of tracheostomy). Does anyone have a better CPT or ICD-9 I could be using to avoid these denials? Any help would be great! Thank you.

 

[lmartien]

Hi Nicole,

I routinely consult with wound care coding and hope I can help you. There is no specific code for debridement of the trachea or tracheal area. Debridement codes are not site specific but only by square centimeters of area debrided. 11042 (subcutaneous debridement) would only be used if your provider clearly documents removal of subcutaneous tissue. Anything less than that (such as partial or full thickness) would need to be coded with 97597 or 97598, again based on square centimeters removed.

In my opinion, your diagnosis code should support the medical necessity for the debridement. You may have already done this but you might query Medicare to see what exactly they mean by not meeting medical necessity, it's not always the diagnosis code Other than that, I can only say - appeal the decision!

 

[nauger]

Thank you!

Thank you very much for the reply!! I greatly appreciate it.