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Code selection depends on your understanding of simple, intermediate, and complex closures. Lesion excisions, as with any open wound, often require a level of repair or closure. Simple repairs are included in the excision codes (CPT® 11400-11646), but intermediate and complex closures are separately billable when medically necessary. Per CPT® guidelines, “The excision of benign […]
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Part 3: Scour the documentation for three key details to correctly code for wound repair. Accurately coding dermatological procedures can be tricky. It is imperative that medical coders understand the anatomy of the skin and can extract specific information from the clinical documentation. We’ve spent the last two months reviewing the codes and guidelines for […]
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I am having a bit of difficulty in coding the wound from an open fracture and any help would be great. Patient fell and had an open fracture of the ankle which the orthopod took to surgery and performed an open repair with plates. Before the main fracture open fracture repair, the orthopod took the patient to the OR to irrigate, debride, and perform a closed reduction of the open fracture. The provider planned on going back to the OR the next day. The second surgery by the same doctor, the surgeon created a lateral incision to plate the fracture and he also made an incision over the open wound site (or extended it, hard to tell). Both procedures have a global period and the orthopod is seeing the patient for post op care for the fracture but he also referred the patient to our wound care clinic to be treated for the open wound (where the bone went through the skin) and this wound was left open secondary to healing. The wound from the bone is not infected nor is there any tissue death and our midlevel at the wound care clinic is treating/providng care for the wound (not the surgical incision, but where the bone went through the skin). I do not believe the wound care doctor can bill for this as it is related to the open fracture and there is no complications at this time or at the time of referral. In addition, the patient is still having post op visits for the fracture by the surgeon for the surgical incisions. The wound clinic and the orthopedic doctors are of the same billing group, but I am only coding for the wound care visits at this time. Can the midlevel charge for office visits for this patient or is that considered part of the global period for the original open fracture? Can anyone please help?
Thanks,
L
I was wondering if anyone could offer any guidance please. I have a Dr. that did 2 debridements on a pt that is in house.
On their rounding days they are applying a would vac/Negative pressure therapy. I was under the impression that this
would get bundled into the 90 day global. I know that the Hospital (PT Department) can charge for it but the Dr. is wanting
to charge for it. Any feed back would be greatly appreciated!
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.
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thank you 
Tissue adhesive, or cyanoacrylate, is like “Super Glue” for the skin. Commonly known as Dermabond® (which is a brand of tissue adhesive sold by Ethicon™), cyanoacrylate is a liquid that may be used to close wounds, either in place of or in addition to other closures methods such as sutures or staples. When used alone, […]
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I have a physician who wants to bill a 27513 ORIF with a 11012 and a complex wound closure? It is my understanding that the closure of the wound would be included in the ORIF. Any help would be appreciated.