Health Information Management

Tip: Anatomy to know when capturing debridement documentation

CDI Strategies, September 30, 2010

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Just because physicians may document the term excisional debridement it doesn’t mean that coders can automatically code the procedure, said Robert S. Gold, MD, CEO of DCBA, Inc. in Atlanta, during the August 5 audio conference “Inpatient Wound Debridement and RACs: Documentation and Coding Improvement Strategies.

“Read the procedure note to see what the provider did because if what the provider did not meet the definition of 86.22, you can’t code it as 86.22—and you shouldn’t code it as such,” he said.

Gold said numerous facilities incorrectly tell physicians to document excisional debridement whenever they use scissors or a knife to perform the procedure. But if the operative note doesn’t support the excising of all necrotic tissue to allow healthy tissue cells to reproduce and close the wound, then such documentation may not hold up to outside auditor’s scrutiny.
 
“If necrotic tissue is not removed down to healthy tissue, you may lose to a RAC if you report 86.22,” he said.

When reviewing documentation, coders should identify the site of the debridement, and if the site is not clearly documented, CDI specialists should query the physician, as this directly drives code assignment, said Gloryanne Bryant, RHIA, RHIT, CCS, CCDS, regional managing director of HIM, at Kaiser Permanente in Oakland, CA. Codes 86.22 and 86.28 are reserved solely for debridement of the skin and subcutaneous tissue.
 
As noted in the 2010 ICD-9-CM Manual, code 86.22 excludes debridement of the following:
  • Abdominal wall (54.3)
  • Bone (77.60–77.69)
  • Muscle (83.45)
  • Hand (82.36)
  • Nail bed or fold (86.27)
  • Open fracture site (79.60–79.69)
  • Pedicle or flap graft (86.75)
Keep in mind that although excisional debridement is a surgical procedure, providers may perform it at a patient’s bedside or in the ER—not necessarily in a surgical suite, said Bryant.



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