Wiki Looking for code more for insurance coverage .. But aftercare of i/d and now graft

[KC7NOA]

Ok,

this is going to be my most detailed question yet ....

I'm not the normal hospital coder and i don't normally handle insurance pre-qualifications... ok -- i don't do this at all, but i'm the only one left in the building thats a coder.

We have a Pt that has had sepsis (staph susceptible to methicillin) and had surgery at a different facility for the infection in he proximal left thumb.

He is DMII and not sure if it a complication from DMII or not .. records are pending from the other facility. (i think it is -- but)

The Pt wants us to continue his care and the our surgeon has debride'd (irrigation yatta yatta) the wound and applied a synthetic skin graft ... the graft was a free sample.

We are now wanting to apply another graft to same site .... probably going to be another debridement ...

Insurance will deny an unspecified wound left thumb ...

and i wanted to code still the sepsis staph type A (im going on memory the next morning -- just got in)

The surgeon stated it as a wound .. but i think that is more of an abscess now .. and should be tested again for staph .... We don't have a lab for staph in our records yet....

anyways ,,, i'm thinking L02.511 and adding history of staph for the insurance pre-qualification

Sorry that i'm not more knowledgeable here ...

 

[thomas7331]

In this question you've said "not sure", "records are pending", "probably going to be", "going on memory", "surgeon stated it as a wound .. but i think that is more of an abscess now", "We don't have a lab for staph in our records yet...."

In this scenario of incomplete information, there is simply no possible way to make any kind of accurate code choices. Best to wait until you have reliable information or documentation in writing and give it a try, and post your questions if you still have some after that. Even if someone here ventures to suggest a code, I wouldn't use it given this level of uncertainty.