Wiki Presternal wound infection

[JulianneG39]

I have a Medicare patient who had a debridement and wound treatment for a presternal wound infection. Original coder used 11042 & 97605, with diagnosis codes 998.59, 041.10, V45.81. Medicare is denying claim for not medically necessary per LCD 23770. The Operative Report clearly states patient has an infection from previous surgical site and the need for re-evaluation and potential closure. Wouldn't this warrant an ICD9 change to 875.1, open wound of chest wall complicated as the primary diagnosis? ICD9 875.1 IS a covered diagnosis under 875.1. Any comments would be appreciated.

 

[ajs]

I have a Medicare patient who had a debridement and wound treatment for a presternal wound infection. Original coder used 11042 & 97605, with diagnosis codes 998.59, 041.10, V45.81. Medicare is denying claim for not medically necessary per LCD 23770. The Operative Report clearly states patient has an infection from previous surgical site and the need for re-evaluation and potential closure. Wouldn't this warrant an ICD9 change to 875.1, open wound of chest wall complicated as the primary diagnosis? ICD9 875.1 IS a covered diagnosis under 875.1. Any comments would be appreciated.

Yes, but you also need to add an E code to describe why. Look at E878.8.

 

[Evelyn Kim]

yes the dx would change to 875.1 and an additional code to describe the circumstances would be needed as well. E878.8 would apply.