Administrative Memos

200701

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 05, 2007
SUBJECT: Clarification of Excisional Debridement Coding
IPRO CONTACTS:

Renato Estrella, MS, RHIA, Director HIM, Medicare/Federal Healthcare Assessment, 516-209-5674

IPRO, the Quality Improvement Organization for New York has received the following clarification in regard to coding for excisional debridement versus non-excisional debridement from the Centers for Medicare and Medicaid Services (CMS). The clarification is based upon guidance provided to CMS by the American Hospital Association's (AHA) Coding Clinic for ICD-9-CM, the official publication for ICD-9-CM coding guidelines. Coding Clinic advice is routinely based upon clinical documentation submitted to the Editorial Advisory Board (EAB) that is related to specific cases. CMS participates on this board and approves all published advice.

Please note that should Coding Clinic provide new or additional guidance, those instructions will supersede and/or provide additional clarification to the information contained in this memo. For complete Question and Answer scenarios, please refer to the Coding Clinic issues referenced below.

ICD-9-CM Official Guidelines for Coding and Reporting - Effective 11.15.2006

Coding of Debridement of Wound, Infection, or Burn

Excisional debridement involves surgical removal or cutting away, as opposed to a mechanical (brushing, scrubbing, washing) debridement.

For coding purposes, excisional debridement is assigned to 86.22.

Nonexcisional debridement is assigned to code 86.28.

Coding Clinic Guidance

Excisional debridement is defined as the surgical removal or cutting away of devitalized tissue, necrosis, or slough (Coding Clinic, 4th quarter 1988).

Unless the attending physician documents in the medical record that an excisional debridement was performed, (definite cutting away of tissue, not the minor scissors removal of loose fragments), debridements of the skin should be coded to 86.28, Nonexcisional debridement of skin, as the index directs. Any debridement of the skin that does not meet the criteria as noted above or is described in the medical record as debridement and no other information is available, should be coded to 86.28, Nonexcisional debridement. Note that other codes are provided for debridement of organs or tissues other than skin (Coding Clinic, 3rd quarter 1991).

Debridement of skin in preparation for further surgery, such as, reduction of a fracture, etc., should not be coded as a separate procedure (Coding Clinic, 2nd quarter 1998).

When multiple layers of the same site are debrided, only the deepest layer of the debridement is coded. For example, an excisional debridement of skin and subcutaneous tissue that extends into the muscle is coded 83.45 (Coding Clinic, 1st quarter 1999).

Effective 7/1/00, excisional debridement may be coded when performed by a nurse, therapist, physician assistant or physician. (Coding Clinic, 2nd quarter 2000) Coding Clinic, 4th quarter 1988, noted, "Nonexcisional debridement may be performed by a nurse, therapist or physician."

Excisional debridement (86.22) is the definite cutting away of tissue that includes cutting outside or beyond the wound margin. This documentation must be present, not just documentation of the use of a sharp instrument (Coding Clinic, 2nd quarter 2004).

Scraping away tissue, minor removal of loose fragments, whirlpool debridement, pulsatile lavage, pulse lavage digressive debridement, mechanical irrigation are examples of nonexcisional debridement (86.28) (Coding Clinic, 2nd quarter 2004).

The use of a sharp instrument does not always indicate that an excisional debridement was performed (Coding Clinic, 2nd quarter 2004).

Excisional debridement of necrotic skin and tissue around an amputation site is coded 86.22. Code 84.3, revision of an amputation stump, is only used when the procedure involves the resection of bone (Coding Clinic, 1st quarter 2005 and Coding Clinic, 2nd quarter 1998).

When coding for debridement of areas other than skin and there is not index entry or guidance provided in the tabular entry, look for other terms such as excision or destruction of lesion of that site (Coding Clinic, 2nd quarter 2005).

Please note that a debridement carried out in conjunction with another procedure is often (but not always) included in the code for the procedure. Index entries and inclusion notes provide guidance (Coding Clinic, 2nd quarter 2005).

Debridement of a wound that is integral to a procedure is not coded separately. For example, an incision and drainage of a postoperative abdominal wound abscess with debridement is coded 54.0, incision of abdominal wound (Coding Clinic, 2nd quarter 2006).

Should you have any questions in regard to this memorandum, please feel free to contact Renato Estrella, MS, RHIA, Director HIM, Medicare/Federal Healthcare Assessment, 516-209-5674.