Tip: Clarifying excisional debridements through Coding Clinic

by Ghazal Irfan, RHIA

An excisional debridement of the skin or subcutaneous tissue is the surgical removal or cutting away of such tissue, necrosis, or slough and is classified to the root operation Excision. Excisional debridement involves the use of a scalpel to remove devitalized tissue. According to AHA Coding Clinic for ICD-10-CM/PCS, Third Quarter 2015, p. 3:

“Debridement of the skin and subcutaneous tissue is a procedure by which foreign material and devitalized or contaminated tissue are removed from a traumatic or infected lesion until the surrounding healthy tissue is exposed. Debridement can be categorized as excisional or non-excisional.”

The same Coding Clinic further directs the coder to code excisional debridement when either “the provider documents ‘excisional debridement’ in the body of the operative report, and/or the documentation meets the root operation definition of ‘Excision.’”

ICD-10-PCS defines an Excision as “cutting out or off, without replacement, a portion of a body part.” Since both excisional and nonexcisional debridement procedures require some kind of “cutting out or off, without replacement” of a tissue, though, how can a coder differentiate between the two excisions and decide which is excisional and which is non-excisional?

Coding Clinic, Third Quarter 2015, pp. 6-7, which describes the following operative report: “Using a sharp scalpel, I first connected the abscess sites and excised down through the subcutaneous tissue with electrocautery. The tissue was in the process of liquefying and was nonviable. The wound measured 8 cm wide by 4 cm long and 2.5 cm deep, and was extensively excised.”

The physician didn’t document the word “excisional debridement” in the body of the operative report, but Coding Clinic advised the coder to code this procedure as an excisional debridement based on the fact that the documentation clearly described an operation that meets the definition of excision. The operative report defined five components of excision that helped it qualify as an excisional debridement.

The Medicare Quarterly Provider Compliance Newsletters for February 2011, October 2011, January 2012, and July 2012 all describe Recovery Auditor (RA) findings where an excisional debridement code is replaced with another excision code which resulted in a DRG shift and Medicare recovering overpayments.

Volume 1, Issue 2, of the February 2011 newsletter clearly summarizes RA findings on excisional debridement and stated that “Hospitals are incorrectly reporting excisional debridement when the wound is debrided using autolytic, enzymatic, or mechanical [whirlpool] debridement. Hospitals should assign … non-excisional debridement of wound, infection, or burn for these non-excisional debridement.”

Going back to Coding Clinic, Third Quarter 2015, p. 3, it states that:

“the use of a sharp instrument does not always indicate that an excisional debridement was performed. Minor removal of loose fragments with scissors or using a sharp instrument to scrape away tissue is not an excisional debridement. A non-excisional debridement of the skin is the non-operative brushing, irrigating, scrubbing, or washing of devitalized tissue, necrosis, slough, or foreign material. Most non-excisional debridement procedures are classified to the root operation ‘Extraction’ (pulling or stripping out or off all or a portion of a body part by the use of force).”

RAs were expected to start auditing in February of this year and they will audit claims submitted over the last three years. In times when reimbursement is drying up for healthcare facilities, and focus is shifting away from volume to value, coders need to understand that every reported code matters.

With excisional debridement, have physicians document the necessary details required to accurately code excisional debridement. Our CDI specialists can play a pivotal role in getting the necessary documentation for coders while the patient is still in the hospital. This will not only eliminate a retrospective query burden, but will expedite the coding process as well.    

Editor’s note: This article originally appeared in JustCoding. Irfan is the coding compliance manager of hospital services for RevWorks AH-Corp and holds a degree in health information management. Opinions expressed are that of the author and do not represent HCPro or ACDIS.