Wiki Incision and drainage w/ debridement

[CaroleF01]

Would this be considered simple (10060) or complex (10061)? Or is there another code that fits better? And would I be able to code the debridement if he mentioned surface area? It seems inherent but I've been known to be stingy with my codes. lol I'm also pretty confident I cannot bill for the assistant.

PREOPERATIVE DIAGNOSES:
1. Abscess in the pannus, lower abdominal wall.
2. Morbid obesity, BMI 52.

POSTOPERATIVE DIAGNOSES:
1. Abscess in the pannus, lower abdominal wall.
2. Morbid obesity, BMI 52.
3. Necrotic fat.

PROCEDURE PERFORMED:
- Incision and Drainage of abscess in the pannus with
- debridement of necrotic fat.

DESCRIPTION OF PROCEDURE: The patient in supine position after adequate
general anesthesia intubation, the abdomen was prepped and draped in the
usual sterile manner. The pannus was elevated to expose the infection,
which was about 1.5 cm necrotic skin in the lower part of the pannus with
cellulitis surrounding it. Using electrocautery because the patient was on
Plavix and she had a previous stent, we used the Bovie to control the
bleeding. So, a transverse incision was made and carried down through
subcutaneous tissue, removing the tissue from the location and draining of
pus pocket in the pannus area. There was necrotic fat, this was removed
and sent to culture. After adequate drainage of the area with irrigation
with saline and controlled the hemostasis with the electrocautery. The
area was packed with Iodoform soaked Kerlix. Sterile dressing was then
applied, and the patient tolerated the procedure well. She was extubated
and returned to recovery in good condition.

Dr. Johnson was first assistant providing exposure and help during the
operation.

 

[mk2001]

Would this be considered simple (10060) or complex (10061)? Or is there another code that fits better? And would I be able to code the debridement if he mentioned surface area? It seems inherent but I've been known to be stingy with my codes. lol I'm also pretty confident I cannot bill for the assistant.

PREOPERATIVE DIAGNOSES:
1. Abscess in the pannus, lower abdominal wall.
2. Morbid obesity, BMI 52.

POSTOPERATIVE DIAGNOSES:
1. Abscess in the pannus, lower abdominal wall.
2. Morbid obesity, BMI 52.
3. Necrotic fat.

PROCEDURE PERFORMED:
- Incision and Drainage of abscess in the pannus with
- debridement of necrotic fat.

DESCRIPTION OF PROCEDURE: The patient in supine position after adequate
general anesthesia intubation, the abdomen was prepped and draped in the
usual sterile manner. The pannus was elevated to expose the infection,
which was about 1.5 cm necrotic skin in the lower part of the pannus with
cellulitis surrounding it. Using electrocautery because the patient was on
Plavix and she had a previous stent, we used the Bovie to control the
bleeding. So, a transverse incision was made and carried down through
subcutaneous tissue, removing the tissue from the location and draining of
pus pocket in the pannus area. There was necrotic fat, this was removed
and sent to culture. After adequate drainage of the area with irrigation
with saline and controlled the hemostasis with the electrocautery. The
area was packed with Iodoform soaked Kerlix. Sterile dressing was then
applied, and the patient tolerated the procedure well. She was extubated
and returned to recovery in good condition.

Dr. Johnson was first assistant providing exposure and help during the
operation.

I would say that would warrant complex for 10061.

 

[asmonger]

The I&D would actually be inclusive to the higher RVU for the debridement of the surface area to the deepest layer (fat necrosis). You would used the sqcm surface for the depth debridement code.

 

[CaroleF01]

The I&D would actually be inclusive to the higher RVU for the debridement of the surface area to the deepest layer (fat necrosis). You would used the sqcm surface for the depth debridement code.

So would you query the surgeon on what the sqcm would be that he actually debrided or is it safe to assume it falls under the first 20 sq cm?

 

[asmonger]

So would you query the surgeon on what the sqcm would be that he actually debrided or is it safe to assume it falls under the first 20 sq cm?

If the dimensions are not provided by the provider report you will want to query the physician and have them provide an addendum to the report.

 

[asmonger]

I would say that would warrant complex for 10061.

A complex I&D is generally defined as an abscess requiring placement of a drainage tube, allowing continuous drainage, or packing to facilitate healing. As a physician, it is important that you document precisely, notating the simplicity or complexity of the procedure, as well as how deep the incision(s) is. Because this wasn't simply "incision" and an excision of necrotic tissue removed a debridement code would be more appropriate.

 

[mk2001]

A complex I&D is generally defined as an abscess requiring placement of a drainage tube, allowing continuous drainage, or packing to facilitate healing. As a physician, it is important that you document precisely, notating the simplicity or complexity of the procedure, as well as how deep the incision(s) is. Because this wasn't simply "incision" and an excision of necrotic tissue removed a debridement code would be more appropriate.

A debridement code does not mean it would be the higher RVU.
Because it wasn't a "simple" I&D is what made it a complicated/complex procedure.
The description for even a simple I&D of an abscess includes "The physician leaves the surgical wound open to allow for continued drainage or the physician may place a Penrose latex drain or gauze strip packing to allow continued drainage."

 

[EmilyC]

Did this patient have a previous surgery or did this abscess form spontaneously?

 

[CaroleF01]

Did this patient have a previous surgery or did this abscess form spontaneously?

spontaneously

 

[EmilyC]

spontaneously

I apologize for the late reply. If it were me, I'd code 10061 because the physician also had to remove necrotic tissue. I would not code debridement since I don't believe this meets the required criteria for debridement, I've done wound care coding for a very long time and if Medicare audited this claim and you billed debridement, they'd deny the claim (It may not be a MCare pt but many insurance companies follow the same guidelines as MCare) Also, placing a drain is not a requirement to use this code per Encoder Pro. "The physician leaves the surgical wound open to allow for continued drainage or the physician may place a Penrose latex drain or gauze strip packing to allow continued drainage"

As far as any assist goes, that would simply depend on whether the CPT codes allows for an assist or not. 10061 does not allow for an assist.

Hope this helps, but please let me know if you have further questions.

 

[CaroleF01]

Thank you all! I am going to go with my initial choice of 10061. I do love this forum!!!

 

[catcattucker]

I apologize for the late reply. If it were me, I'd code 10061 because the physician also had to remove necrotic tissue. I would not code debridement since I don't believe this meets the required criteria for debridement, I've done wound care coding for a very long time and if Medicare audited this claim and you billed debridement, they'd deny the claim (It may not be a MCare pt but many insurance companies follow the same guidelines as MCare) Also, placing a drain is not a requirement to use this code per Encoder Pro. "The physician leaves the surgical wound open to allow for continued drainage or the physician may place a Penrose latex drain or gauze strip packing to allow continued drainage"

As far as any assist goes, that would simply depend on whether the CPT codes allows for an assist or not. 10061 does not allow for an assist.

Hope this helps, but please let me know if you have further questions.

I know I am highjacking someone else's question, but I am trying to code a surgery where they say they do an I&D of a posterior shoulder abscess that wound up being a staph infection. Sharp skin incision was made with immediate purulent material. cultures were obtained. This was then irrigated and a key elevator was used to debride all the necrotic fat and debris. A ronguer was also utilized. And for once my surgeon gave me measurements so those are 9cm x 7cm and 3 cm deep. Which code would you suggest? The code that the surgery scheduler put in was 23031, but I'm not sure about that because it doesn't mention the debridement. I'm awful at these. Can you please help me?