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For other articles and previous issues click here. September 12, 2005 Coding
for Debridement Dorland’s Medical Dictionary defines debridement as “the removal of foreign material or devitalized tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed.” Debridement can be performed on skin, muscle, and bone in addition to other tissues. Appropriate ICD-9-CM code assignment will depend on the documentation provided in the medical record. If the documentation is unclear, then it may be appropriate to query the physician for clarification. Methods of Debridement • wet-to-dry dressings: wet dressings are applied to the wound and allowed to dry (When the dry dressing is removed, it pulls off the dead tissue.); • application of medications that contain enzymes to dissolve dead tissue; • application of medicated dressings; • whirlpool baths; and • surgical debridement with scalpel or scissors to remove dead tissue. Documentation Requirements • Method of debridement • Depth of debridement — Did the health care provider debride beyond the dead or damaged tissue down to healthy, viable tissue? • Instruments used to perform the debridement — Did the healthcare provider use a scalpel or scissors? Scissors may be used to cut away loose fragments, which is not indicative of excisional debridement. Use of a scalpel or blade is a better indication that an excisional debridement was done. Code assignment cannot be based solely on the instrument used, but does assist in description of the type of debridement. Documentation of the procedure must be in the body of the medical record, such as the progress notes or operative report. The procedure can be performed by a physician, nurse practitioner, enterostomal nurse, physical therapist, or physician assistant. According to AHA Coding Clinic for ICD-9-CM, “It is appropriate to assign a procedure code based on documentation by a nonphysician professional when that professional provides the service” (AHA Coding Clinic for ICD-9-CM, 2004, fourth quarter, pages 138-139). This advice applies only to procedure coding. The documentation in the medical record needs to be descriptive enough to support code assignment regardless of who performs the procedure. Excisional Debridement Nonexcisional debridement, which is classified to code 86.28, includes “brushing, irrigating, scrubbing, or washing of devitalized tissue, necrosis, or slough” (AHA Coding Clinic for ICD-9-CM, 1988, fourth quarter, page 5). Description of nonexcisional debridement may include: • minor removal of loose fragments with scissors; • scraping away tissue with a sharp instrument; • whirlpool debridement; • digressive debridement with pulse lavage; • mechanical lavage; • pulsatile lavage; • mechanical irrigation; • high-pressure irrigation; • incision and drainage; and • debridement, not otherwise specified. Debridement Through Multiple
Layers Debridement Integral to
Procedure Debridement of Amputation
Stump Coding and sequencing for debridement are dependent on physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, of 3M Health Information Systems (800-367-2447), a supplier of coding and classification systems to nearly 5,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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