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Debridement

Jamie Posted Thu 18th of June, 2020 14:26:55 PM
For coding wound debridement of the skin only the Epidermis & Dermis layers. Would this be included in the E/M?
SuperCoder Answered Fri 19th of June, 2020 07:04:01 AM

Hi,

 

If the patient is schedule for the debridement, then only debridement code will be coded. However, if the doctor performs medically reasonable and necessary full examination (history, physical and MDM) and decides for debridement, an E&M service may be separately reportable with debridement code.

 

[Note: As per NCCI guidelines, if a procedure has a global period of 000 or 010 days, it is defined as a minor surgical procedure.  (Osteopathic manipulative therapy and chiropractic manipulative therapy have global periods of 000.)  In general E&M services on the same date of service as the minor surgical procedure are included in the payment for the procedure. The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service.  However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25.  The E&M service and minor surgical procedure do not require different diagnoses.  If a minor surgical procedure is performed on a new patient, the same rules for reporting E&M services apply.  The fact that the patient is “new” to the provider is not sufficient alone to justify reporting an E&M service on the same date of service as a minor surgical procedure.  NCCI contains many, but not all, possible edits based on these principles.]

 

Please also check below link:

https://www.supercoder.com/coding-newsletters/my-emergency-medicine-coding-alert/debridement-3-faqs-help-solve-your-eds-debridement-questions-162030-article

 

 

Hope this helps!

 

Thanks

Jamie Posted Tue 23rd of June, 2020 13:25:57 PM
I reviewed the link, and the CPT code is states to use for epi/dermal skin is a deleted code (11040). The patient only came in for Debridement - (Procedure Note:Skin: Superficial linear abrasion from just below the left knee extending to the left ankle. Granulation tissue has increased at edges by 1-2 cm with trace central yellow sloughing. Minimal wound debridement was performed using metal curette. Patient tolerated procedure well. Wound was dressed with Xeroform, nonadherent gauze, and compression wrap) I queried the provider and they did not debride the subcutaneous tissues (CPT 11042) so I would this debridement of epi/dermal skin be included in the E/M or would CPT 11000(Debridement of extensive eczematous or infected skin) be more appropriate for the scenerio above? Thanks for your help.
SuperCoder Answered Wed 24th of June, 2020 05:14:23 AM

Hi,

 

As per the provided documentation, the patient only came in for debridement and physician has not performed E&M. So, only debridement code will be coded.

According to provided procedure note, appropriate CPT will be 97597.

 

Active wound care management involves procedures such as debriding areas of devitalized tissue using a process such as sharp excision, high-pressure waterjet, or non-selective processes such as abrasion or enzyme treatments. According to CPT® guidelines, the intent of these procedures is “to remove devitalized and/or necrotic tissue and promote healing.”

You’ll report these procedures using codes such as the following:

97597 and +97598 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area…)

97602 (Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session)

 

Please check the below link for better understanding:

https://www.supercoder.com/coding-newsletters/my-general-surgery-coding-alert/removal-master-debridement-coding-with-4-tips-164489-article

 

Hope this helps!

 

Thanks

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