Phyllis Posted Wed 27th of November, 2013 16:17:23 PM
How would you code debridement or washout of the dura if the brain is already exposed from a previous craniotomy?
SuperCoder Answered Thu 28th of November, 2013 09:11:30 AM
Documentation tip: Debridement of devitalized tissues and repair of dural defects is an integral part of operative management of depressed skull fractures when using CPT® 62010. Do not forget to check for any debridement or repair in the operative note.
“There may be circumstances in which a depressed skull fracture is associated with a subdural or intraparenchymal hematoma requiring craniectomy or craniotomy,”. “In such circumstances, you do not separately report the treatment of the depressed fracture is an incidental part of the closure of the more extensive procedure of craniotomy for evacuation of the subdural or intraparenchymal hematoma.”
Coding for debridement and wound dehiscence following spinal surgery is the same as for that following cranial procedures: When returning to the OR for debridement, the most appropriate codes are 11040-11044 (Debridement ), depending on the depth of the excision. A new diagnosis (e.g., 998.59, Other postoperative infection) should accompany the claim. The "complications" portion (998-999.9) of ICD-9 lists numerous possible causes of postoperative spinal problems. For wound dehiscence (998.3, Disruption of operation wound), the correct procedure code is 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated). Even these may not reflect the extent and depth of spinal wound dissection and the extra care required, and may need individual consideration.