Wiki Need help with wound code

[knperry]

Hello all!
I'm having some issues with deciding whether or not to use the wound care codes. Can anyone give me a little detail on these codes. For example below is are notes for wound debridement. Would I go with the codes in the 10000s or would I use the would care codes in the 90000s. Any help will greatly be appreciated.

NAME OF PROCEDURE: Local wound debridement and delayed primary closure.



HISTORY OF PRESENT ILLNESS: This is a 75-year-old female with history of PEG

tube placement with erosion of PEG tube site. She underwent gastrocutaneous

fistula take down and new PEG tube placement earlier in her hospitalization;

however, she has had dehiscence of her wound at the gastrocutaneous fistula

site. This was felt to be amenable to local wound debridement and delayed

primary closure.

DESCRIPTION OF PROCEDURE: Informed consent was obtained from the son and all

questions were answered. The patient was brought back to the operating room

suite and induction of anesthesia with general anesthetic was performed. The

patient was prepped and draped in the usual sterile fashion. A time-out was

then performed, verifying correct patient, site, procedure and signature of

informed consent. The wound was inspected and minimal amount of necrotic

debris was evident at the edges of the wound as well as the base of the wound.

This was sharply debrided using a 10-blade scalpel until fat and a minimal

amount of bleeding was identified.



The wound was then inspected for adequate hemostasis and the decision was made

at that time to proceed with delayed primary closure. PDS suture was used to

close the wounds in a simple interrupted fashion with a total of 6 simple

interrupted sutures being placed. The wound was inspected for adequate

hemostasis and when this was determined to be the case, the procedure was then

concluded. The wound was dressed with Primapore tape. The patient was

withdrawn from anesthetic. The patient was transferred back to the ICU in

stable condition.

 

[espressoguy]

It is a little unclear how deep the debridement was. Your provider states, "This was sharply debrided using a 10-blade scalpel until fat and a minimal amount of bleeding was identified."

I have asked all of my wound care providers to include the statement, "down to and including. . ." in their note. This helps identify specifically what was debrided and which debridement code is appropriate. In your example it comes down to whether subcutaneous tissue (i.e. fat) was debrided. If it was, then 11042 is appropriate. If not, then 97597 would be appropriate.

Also, your provider did not indicate the size of the debridement. The initial debridement code includes the first 20 sq cm. If the debridement was greater than 20 sq. cm. then you would be able to use the appropriate add on code as well.