Ask the Expert

This month’s selection:
Is it appropriate to code 86.22, Excisional debridement of wound/infection/burn, for the surgical removal of devitalized tissue by use of a rongeur?

Mari Lyn Brewer, CCS
RAC Coding Quality Analyst
The Ohio State University Wexner Medical Center

Response:
It would not be appropriate to report code 86.22 for surgical removal of devitalized tissue by use of a ronguer.

In the ICD-9-CM index under the main term “debridement,” there are just two subterms: excisional and nonexcisional. Code 86.22 is accessible only under excisional. Also note that according to Coding Clinic (first quarter 2013, “Providers should specifically document the type of debridement. Clear and concise documentation is needed in order to accurately report excisional debridement.”

What this tells us is that in order to assign code 86.22, the physician must document that an excisional debridement was performed. The type of instrument used is not the determining factor in code assignment. If there is any question as to whether the debridement was excisional vs. nonexcisional, then the physician must be queried for clarification. A ronguer is defined as a forcepslike instrument for cutting tough tissue. The use of a ronguer or any other sharp instrument does not allow the coder to make an assumption that the debridement was excisional.

— 3M Health Information Systems 3M Nosology Services Team