The Central Office has received numerous questions about the information published in Coding Clinic Second Quarter 2004, page 5, which stated that excisional debridement involves cutting outside or beyond the wound margin. Healthcare facilities have stated that some local review organizations are interpreting this information literally. Coders are seeking clarification whether excisional debridement must involve cutting outside or beyond the wound margin and if the provider's documentation needs to specifically state this in order to assign code 86.22.
The clinical information published in Coding Clinic regarding excisional debridement and cutting outside of the wound margins was provided for informational purposes to aid the coder's understanding. It was not intended as clinical criteria to report code 86.22. The establishment of clinical parameters for code assignment is beyond the scope of authority of the Editorial Advisory Board for Coding Clinic for ICD-9-CM. All code assignment is based on provider documentation. Clear and concise documentation is required in order to accurately report excisional debridement. The link between good provider documentation and correct coding has always been emphasized in Coding Clinic. It is critical that hospitals work with their providers to ensure that the documentation used to support excisional debridement clearly describes the procedure performed. Documentation of excisional debridement should be very specific regarding the type of debridement. If the documentation is not clear or there is any question about the procedure, the provider should be queried for clarification.
The following questions and answers are examples related to coding excisional debridement:
On the wound progress note the physician documented that an excisional debridement was carried out. Would this be coded as excisional debridement?
Yes, assign code 86.22, Excisional debridement of wound infection or burn.
The physician debrided a coccyx wound with sharp excision down to the fascia and bone. How should the debridement down to the bone be coded?
Assign code 77.69, Local excision of lesion or tissue of bone, other, for the sharp debridement of the fascia down to the bone. When multiple layers of the same site are debrided, assign only a code for the deepest layer of debridement. Refer to Coding Clinic, First Quarter 1999, pages 8 to 9, for additional information regarding extensive wound debridement.
The patient, who is status post amputation of the fourth digit, presented with a diabetic foot ulcer and underwent debridement of the ulcer. During the procedure, fibrinous tissue was identified superficially in the wound field and was sharply debrided. Since the debridement was described as sharp, should this be coded as excisional or nonexcisional debridement?
Query the provider to determine whether the debridement was excisional or nonexcisional. As previously stated in Coding Clinic, Second Quarter 2004, page 5, "The use of a sharp instrument does not always indicate that an excisional debridement was performed."