Wiki Degloving Debridement -- 11043 vs 20103 vs ????

[Laxwido]

Hello Group!
Looking for thoughts, opinions, and references if there are any out there.
I have a MASSIVE degloving from a MVA. From elbow to wrist, skin peeled down inside out, > 625sq cm. We explored looking for tendon/muscle/nerve damage then spent an hour picking out grass, gravel, and dirt from the muscles. 11043 (add on 11046) doesn't seem right, but 20103 says penetrating wound (although the Header reads 20100-20103 Traumatic Wound).

Where do you go for these traumatic degloving washouts?

 

[MI_CODER]

The main question to ask is "Does this qualify as a penetrating wound?"

According to this website:

Non-penetrating wounds: These are usually the result of blunt trauma or friction with other surfaces; the wound does not break through the skin, and may include:
Abrasions (scraping of the outer skin layer)
Lacerations (a tear-like wound)
Contusions (swollen bruises due to accumulation of blood and dead cells under skin)
Concussions (damage to the underlying organs and tissue on head with no significant external wound)

Penetrating wounds: These result from trauma that breaks through the full thickness of skin; reaching down to the underlying tissue and organs, and includes:
Stab wounds (trauma from sharp objects, such as knives)
Skin cuts
Surgical wounds (intentional cuts in the skin to perform surgical procedures)
Gunshot wounds (wounds resulting from firearms)

Based on the documentation and the definitions, I would code CPT 20103. A degloving injury is a type of avulsion in which an extensive section of skin is completely torn off the underlying tissue, severing its blood supply. The provider states that an hour was spent picking out dirt, gravel and grass from the muscle. This indicates that the injury broke through the full thickness of skin and reached down to the underlying tissue (therefore, by definition, making this a penetrating wound).

 

[fish4codes]

I have an almost identical case I am in the process of coding also; however, when I compared the CPT lay descriptions I felt the 11043 , +11046 to be more appropriate - as I also questioned the 20103. The postop dx given is "left forearm and elbow laceration with skin loss measuring approximately 20 cm x 6 cm (it was a motorcycle crash). Procedure, "I&D left forearm/elbow wound 20 x 6 cm including skin, subcu, ,muscle and fascia. In the OP note describes gross contamination, skin damage, debridement to fascia, wound was to contaminated to close. I also coded the diagnose to open wound of elbow and forearm. Thoughts???

11044, 11047
The physician surgically removes foreign matter and contaminated or devitalized bone (including epidermis, dermis, subcutaneous tissue, muscle, and/or fascia, if performed) CAUSED BY INJURY, infection, wounds (excluding burn wounds), or chronic ulcers. The physician uses a scalpel to excise the affected tissues into the bone. Depending on wound size, closure may be immediate or delayed. The wound may be packed open with gauze and require immediate or delayed reconstruction. Report 11044 for the first 20 sq cm or less and 11047 for each additional 20 sq cm or part thereof.

20103
The physician explores a penetrating wound in the operating room, such as a gunshot or stab wound, to help identify damaged structures. Nerve, organ, and blood vessel integrity is assessed. The wound may be enlarged to help assess the damage. Debridement, removal of foreign bodies, and ligation or coagulation of minor blood vessels in the subcutaneous tissues, fascia, and muscle are also included in this range of codes. Damaged tissues are debrided and repaired when possible. The wound is closed (if clean) or packed open if contaminated by the penetrating body. Report 20100 for exploration of a neck wound. Report 20101 for exploration of a chest wound. Report 20102 for exploration of an abdomen, flank, or back wound. Report 20103 for exploration of a wound to an extremity.