Wiki Still an Abscess, or Non-Healing Operative Wound?

[TARAGRANT]

Wound care coding question! I've been working on educating the physicians I work with on ICD10 since it became effective. There has been a constant ongoing debate between the three of them as to what diagnosis to use in a particular situation involving abcesses. When an abscess is incised and drained, and they are referred to us for treatment because the wound will not heal, one physician wants to now call the abscess a nonhealing operative wound because they state they've had surgery, while the other two say it's still an abscess.I have posted the question in social media coder groups. When it was suggested that we go with the diagnosis on the referral, I have suggested that to the doctors and, unfortunately, the referrals basically state "wound care", "wound left foot" or "wound abdomen" - they dont' specify what type of wound. I need help to settle this matter once and for all. Any documentation that I can provide them is greatly appreciated, as I have researched and cannot find anything definitive.

 

[thomas7331]

My thought is that you're mixing clinical and coding issues here, which may be a source of some of the confusion. My feeling is that this is more of a clinical issue than a coding question and won't be resolved by turning to coding guidelines - the correct diagnosis and the correct ICD-10 code are separate things.

Whether the patient's active diagnosis is best described as an abscess or a non-healing wound is a clinical decision and up to the provider, and providers will not always agree on how to diagnose a patient's condition, nor should they have to. The ICD-10 guidelines instruct that "assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis." As I see it, coding is a reporting role, and the task is to assign the code that most accurately represents the diagnostic assessment that the provider has made - it is not really within the scope of coding to review the record or patient history to assess whether or not we agree with the provider's diagnosis or to advise them on how they should word their assessment. As a coder with limited clinical background, I personally would not attempt to try to answer or to 'settle' this and would leave it to the clinicians to work out among themselves, but if it's a pressing matter, you might consider involving someone with a CDI/clinical documentation improvement background who can help work with both you and the providers to come to a solution.

 

[TARAGRANT]

My thought is that you're mixing clinical and coding issues here, which may be a source of some of the confusion. My feeling is that this is more of a clinical issue than a coding question and won't be resolved by turning to coding guidelines - the correct diagnosis and the correct ICD-10 code are separate things.

Whether the patient's active diagnosis is best described as an abscess or a non-healing wound is a clinical decision and up to the provider, and providers will not always agree on how to diagnose a patient's condition, nor should they have to. The ICD-10 guidelines instruct that "assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis." As I see it, coding is a reporting role, and the task is to assign the code that most accurately represents the diagnostic assessment that the provider has made - it is not really within the scope of coding to review the record or patient history to assess whether or not we agree with the provider's diagnosis or to advise them on how they should word their assessment. As a coder with limited clinical background, I personally would not attempt to try to answer or to 'settle' this and would leave it to the clinicians to work out among themselves, but if it's a pressing matter, you might consider involving someone with a CDI/clinical documentation improvement background who can help work with both you and the providers to come to a solution.

I appreciate your response. Let me be clear, I am aware that ICD-10-CM simply provides a code number once the diagnosis has been established by the physician. I have discussed with the physicians that I simply assign the ICD10 code and CPT code based on the information they give to me. I'm not agreeing with or disagreeing with any of the physicians, questioning their ability to diagnose a patient, or instructing them as to how they should assess and diagnose a patient. With that being said, the entire debate was brought on by one doctor in the group treating a patient of another doctor in the group, while the original doctor was on vacation. The second doctor called the wound a non-healing operative wound while the original doctor continued to call the wound an abscess after the I&D, and yet it's the same wound. Once the original doctor realized the discrepancy, a discussion began on the topic. They came to me asking me to find clarification as to what they should be calling the wound once an I&D has been performed, if those coding guidelines exist, so as to have continuity in the patient record. If there are no guidelines, that's perfectly fine. I am more than willing to take back to them that there are no guidelines as to such. If they want to call it an operative wound, they can call if an operative wound. If they want it to remain an abscess after I&D, it can remain an abscess. I will continue to assign ICD10 codes to whatever diagnosis they give me. I am simply asking if there are any coders with a wound care background that have any suggestions with a situation similar to ours.

 

[LuckyLily]

AAPC has a webinar scheduled for 1/10/18 for Chronic Wound Care. This would be the perfect forum for you to ask your question. It would also be beneficial if your providers would be able to participate. I'd be interested to see what the answer would be.

 

[TARAGRANT]

AAPC has a webinar scheduled for 1/10/18 for Chronic Wound Care. This would be the perfect forum for you to ask your question. It would also be beneficial if your providers would be able to participate. I'd be interested to see what the answer would be.

I WASNT AWARE OF THAT!!! Thank you so much for that information! I appreciate your response!