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Tag Archives: Debridement

Selective Debridement Crosswalk

Posted on by
Hello,

I work for a wound care company that provides services in many different settings. I am looking to map Selective Debridement CPT (97597) to ICD-10 PCS Codes. When referencing the book, it wants me to distinguish between Excisional and Non-Excisional. I know that most Sharps debridements, Subcutaneous, Muscle, & Bone are excisional. I cannot find clarification on a Selective Sharps Debridement and would appreciate if anybody can give me information on what they code for in this scenario in their practice. Thanks in Advance!

Medical Billing and Coding Forum

CPT for debridement

Posted on by
Gently debrided them today with gauze and peroxide, cleansed them and applied bacitracin gel to each– is what our MD performed.
This is what was debrided:
Loss of skin tissue substantially, appears to be full thickness. The areas are open.
Which CPT fits best? I know 97602 for some insurance companies denies, so I’m looking for a different code.
Thank you

Medical Billing and Coding Forum

Please help! – Breast–IRRIGATION & DEBRIDEMENT BREAST WOUND / ABSCESS

Posted on by
Hello, which debridement code should I use along with implant removal code?

Operative Procedure: A 3.5 cm diameter circle at her mastectomy scar, and a 2.5 cm diameter circle superiorly where her tissue expander port site was previously located. Her implant is grossly visible at both of these locations. There is a thin intervening skin bridge connecting these 2 locations. With her consent a photo was taken in preoperative holding area and scanned into media prior to surgery. The skin bridge is clearly not viable and it is incised. The implant is removed and sent to pathology for gross examination. The implant pocket is then copiously irrigated with 3 L of pulse lavage saline. There is an inflammatory rind evident in the pocket. However there is no gross purulence. At the level of the prepectoral plane under direct visualization using cautery the skin flaps are elevated circumferentially. Using a 15 blade the skin edges were then debrided to remove the circular skin defects which leads to a vertical defect measuring 11 cm her left chest wall. The skin edges do bleed with this tissue removed. The mastectomy skin is sent to pathology for examination. 30 cc of quarter percent Marcaine with 1:100,000 epinephrine is injected for local anesthetic and hemostasis. With the wide undermining I am able to close the skin flaps with only minimal tension. Hemostasis is achieved using cautery. Saline was used for additional irrigation. A 10 French round JP drain is placed within the pocket. 3-0 Vicryl sutures were used to reapproximate the dermis. 4-0 Monocryl horizontal mattress sutures were used to loosely reapproximate the skin edges. A 13 cm Prevena incisional wound VAC is placed over the incision. A drain sponges placed around the drain site. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
*

thank you :)

Medical Billing and Coding Forum

need help with code for debridement note

Posted on by
Hi, colleagues; after being away for some time returning in a new position, and need some CPT coding guidance. Here’s an extracted chart note: This will probably be easy for those of you who deal with these procedures regularly.

LT great toe wound is suspicious for an infected gouty arthritis versus osteomyelitis.
Description of Procedure: After informed consent PAT was taken to operative suite & sedated by anesthesia service. LT foot was then prepped draped standard fashion. We then anesthetized the base of toe & following this explore the tip of toe wound. This clearly extended to distal phalanx which was gently debrided. Cultures were obtained & specimens were sent for biopsy. Dressing was applied following a counterincision on lateral aspect of toe where IV tubing was placed for drainage. Patient tolerated procedure well/discharged home in stable condition

No measurements are supplied.

I see debridement and then an incision for drainage. Are they both considered components in the debridement process, and if so, choices are in the 110XX code range? Also, might 10140 be a consideration?

Medical Billing and Coding Forum

debridement help please

Posted on by
can someone help explain to me how to code this thanks

Procedure:
Sharp excisional debridement of muscle 13 x 4 cm ?11043 11046 x2
Primary closure of fasciotomy sites 13 x 4 cm and 10 x 2 cm ?
Findings:
Nonviable muscle on the lateral aspect of the fasciotomy site and this was sharply debrided down to bleeding healthy muscle.

*
Procedure Details:
The patient was operating room placed in supine position. Gen. anesthesia was induced. The right lower extremity was prepped and draped in the usual sterile fashion. A timeout was performed verifying correct patient and procedure. The previous fasciotomy sites were explored and on the lateral incision the muscle was noted to be dark and dusky. This was sharply excised with some bumps his back to healthy bleeding muscle. Total muscle debrided measured approximately 13 x 4 cm. The medial fasciotomy site was explored and the muscle viable. Both wounds irrigated copiously. Hemostasis was achieved. The wounds were then closed with interrupted deep dermal absorbable suture and the skin was closed with staples and interrupted nylon sutures. Skin edges came together without any tension. Incisions were then dressed. At this point the procedure was ended.
*
Instrument, sponge, and needle counts were correct prior to closure and at the conclusion of the case. The patient tolerated the procedure well and was transferred to the PACU in stable condition.

Medical Billing and Coding Forum

need help on debridement code please

Posted on by
So our doc wants 11004 but I just don’t think I see that he is in the perineum region. I am new to Gen Surg coding and struggling.
I keep leaning towards 11043 with an add on but I can’t do the add on because he doesn’t give me the measurements.

Thank you in advance!!

procedure: Wide sharp excisional debridement of skin, subcutaneous tissue and fascia with drainage of ischiorectal and left buttock abscess

The patient has necrotic tissue and foul purulent drainage from the left buttock. This area is opened up and the underlying skin, subcutaneous tissue and fascia were found to be necrotic. This is sharply excised and pockets up puss and necrotic tissue were excised with Metzenbaum scissors and a 10 blade scalpel. Electrocautery was used to assure hemostasis. The delineation of the sharp debridement is made by evidence of bleeding from the sharp cut surfaces of the skin, subcutaneous tissues and fascias and underlying muscle. An S-shaped probe was used to look for any fistula tracts. There are several deep crypts but there is no connection to the anorectal region, anal canal or distal rectum. Hemostatis is assured. The infection and pockets of abscess do not extend to the contralateral side. There is no FB or tumor. Area is packed with iodoform packing gauze.

Medical Billing and Coding Forum

Debridement denials 10005 & 10008

Posted on by
During an intrathecal baclofen pump replacement, the surgeon says he completed a debridement and coded as 11005 & 11008. Medicare denied both, saying 10008 did not have a qualifying claim or service and 11005 for being incompatible with another code. Below is a clip from the operative note. Any ideas on the proper coding here?

Attention was first turned to the abdominal incision. Incision was made using a scalpel. Dissection was carried down to the level of the pocket using monopolar cautery. Upon entering the pocket, a yellow white slightly viscous fluid was encountered. The fluid was swabbed and sent for stat Gram stain and culture. The pocket was then entered and the pump was explanted from the pocket. The pump was then placed in an antibiotic solution. Upon inspection, the catheter was noted to be intact through the connector sites in between the pump catheter and the lumbar catheter. The side port was accessed using a 3 mL syringe and a Huber needle and clear CSF was aspirated with some difficulty, showing that the catheter was patent. The lab called back and stated that the fluid did not have any organisms or leukocytes making the risk of infection low. Therefore, given the fact that the catheter was functioning and the pump was not infected, decision was made to reimplant the pump. The current Medtronic SynchroMed II pump that was soaked in antibiotic solution was then reimplanted. All the fluid was copiously irrigated out with antibiotic solution as well as suctioned away. The pump was then re-primed and filled with baclofen and attached to the current catheter system. Clear CSF was noted to be egressing throughout the whole system. The new pump then was attached to the catheter system and with aspiration of the sites very easily.

Medical Billing and Coding Forum

Debridement question

Posted on by
Hello,

I have the following codes for this case:

11042 – Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
11045 – Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof
11045 – Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof

The operative report states “A total of 60 sq. cm. of skin and subcutaneous necrotic fat was debrided and excised.” Why wasn’t a code(s) for excisional debridement of the skin (dermis) assigned?

What are the appropriate modifiers to append?

Thanks

Medical Billing and Coding Forum

Nail avulsion, nail debridement, 1ncision and drainage

Posted on by
Hi Just wanted to get clarification on the procedures below and wondering if it’s coded correctly. Any thoughts?

PROCEDURE Each nail border was debrided of callused nail grooves, incurvated and ingrown areas, hypertrophied cuticle and mycotic and necrotic debris. Betadine solution was used to cleanse each nail plate for antiseptic reasons after debridement was performed.

OPERATION the affected areas were prepped in the usual sterile manner. The initial approach was made with an english nail splitter using that instrument to excise the nail border spicule along the full length of the nail from the tip to the eponychial attachment., Using a freer elevator and a medium hemostat the nail border was removed. The defect was curretted clean removing all necrotic and calloused nail groove and diseased cuticle.

The pus pocket paronychia abscess was incised and drained and any visible necrotic skin and tissue removed., The surgical wound was dressed using a Betadine pad drain, antiobiotic ointment, 4×4 digital cut, kling and stockinette.

CPT: 11721, 11730, 10060

Medical Billing and Coding Forum