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10140, Excision or debridement? postop hematoma, necrosis

Tanesha Posted Tue 26th of November, 2019 22:03:30 PM
Should I code debridement or excision along with 10140? Leaning toward excision because of closure. Op Excerpt: There was a breakdown of the closure and disruption of the vaginal mucosa medial to the incision site. The wound area was then opened with excision of slightly necrotic appearing tissue at the suture line and the wound bed was then copiously irrigated with approximately 200 mL of sterile saline until all clot was removed. Wound bed was slowly explored and all clots evacuated. There was debridement of mildly necrotic appearing tissue in the left aspect of the wound bed until healthy appearing tissue was present throughout. Wound bed was then re-examined and closure was felt to be appropriate, and therefore, the wound bed was closed with 3-0 Vicryl and three layers of interrupted suture and running closure. A small space in the posterior wound bed was left open, and with closure at the vaginal mucosal and epidermal level, a Word catheter was placed and the epidermal layer was closed around the Word catheter with interrupted sutures of 3-0 Vicryl.
SuperCoder Answered Wed 27th of November, 2019 08:40:56 AM

Hello Tanesha,

Thank you for your question

 

As per the above documentation, you should report CPT® code 10140 (for clot evacuation) and code 12041 (for debridement of necrotic tissue and layered closure).

 

In CPT® code 12041, After inspection, the wound is irrigated with normal saline, and proper debridement of the wound is performed. Contaminated single–layered wounds need extensive cleaning to remove particulate matter. Now attention turns to repair of the wound. The wound edges are brought together to form a linear closure. Suture of the inner layer of skin (subcutaneous, dermis, and/or superficial fascia) with absorbable suture is done. External layer is sutured in a linear fashion. Dermabond is applied to the wound.

 

Note: Per CCI Edit, there is a bundling conflict between code 10140 and 12041. Append modifier 59 (Distinct Procedural Service) with code 12041, to rule out the bundling.

 

Also check your medical documentation for the global period. There might be chances that the current procedure might fall under the global period of the primary procedure.

 

Hope that helps!

Thanks

Tanesha Posted Wed 27th of November, 2019 12:24:23 PM
Thank you for your response. Did you mean complex repair as this includes debridement? 12041 is intermediate and doesn't mention debridement.
SuperCoder Answered Thu 28th of November, 2019 06:10:57 AM

Hello Tanesha,

Thank you for your additional query

 

As per your previous documentation, there was debridement of mildly necrotic appearing tissue in the left aspect of the wound until healthy appearing tissue was preset throughout.

 

In order to qualify the procedure for complex repair, the documentation should include either exposure to bone, cartilage, tendon, or neurovascular structure level OR debridement of wound edges with extensive undermining OR stents OR retention sutures. In your case, there was no extensive debridement performed, only mild debridement of necrotic tissue was performed along with layered closure.

 

Based upon the documentation, you should report an intermediate repair, as it includes the repair of wound and require layered closure of one or more of the deeper layers of subcutaneous tissue, in addition to the skin closure. It includes limited undermining. It also includes the closure of contaminated wounds that have required extensive cleaning or removal of particulate matter (mildly necrotic tissue, as per your case).

Hence, you are advised to report an intermediate repair instead of complex repair for the above documentation.

 

For more information, kindly go through the under-mentioned link. Do let us know, in case you’re unable to access the newsletter.

https://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/wound-repair-from-closure-to-cleaning-details-drive-code-choice-162120-article

 

Hope that helps!

Thanks

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