Health Information Management

Q&A: Determine documentation difference between skin graft and debridement

CDI Strategies, July 7, 2011

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Q:  I have been trying to determine whether a skin graft includes debridement. Based on what I have read in the Official Guidelines for Coding and Reporting and Coding Clinic for ICD-9-CM, I believe that I should report two separate codes. Otherwise, the graft code would have an includes note indicating the debridement is inherent in the code. I work in an acute care center with a burn unit and have been striving for accuracy and consistency.

A:  In the scenario described, it’s appropriate to assign only a code for the skin graft, per Coding Clinic, third quarter, 1991, p. 18–19. The last sentence in the Coding Clinic answer states:
 
“Debridement of the skin that is preparatory to further surgery such as reduction of fracture, etc., should not be coded as a separate procedure.”
 
Coding Clinic, fourth quarter, 1999, p. 15 addresses a situation in which a patient who is status post open transmetatarsal amputation of the right foot is readmitted for delayed closure of the amputation site. The Coding Clinic provided the following information:
 
“The surgeon debrided the necrotic tissue surrounding the amputation site, harvested skin from the patient's thigh and closed the wound with a split thickness skin graft. An ulceration of the distal right leg was also noted and repaired with split thickness skin graft.”
 
Coding Clinic advises the coder to assign code V58.41 (encounter for planned postoperative wound closure) as the principal diagnosis and code 707.1 (ulcer of lower limbs, except decubitus) as a secondary diagnosis. Coding Clinic also states:
 
“Assign code 84.3 (revision of amputation stump) and code 86.69 (other skin graft to other sites) for the debridement and closure of the amputation site via split-thickness skin graft. Code 86.69 may be assigned twice, if desired, to show the repair of the leg ulcer.”
 
As you can see, procedure code 86.69 (other skin graft to other sites) includes the debridement and closure of the amputation site via split-thickness skin graft.
 
Editor’s note: Sandra L. Sillman, RHIT, PAHM, of Henry Ford Hospital & Health Network, answered this question. She is a DRG Coordinator who performs inpatient coder and physician education. Her e-mail address is ssillma1@hfhs.org. This answer was provided based on limited information submitted to JustCoding.com where this Q&A was originally published. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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