By Glenn Krauss,BBA, RHIA, CCS, CCS-P, CPUR, FCS, PCS, CCDS, C-CDI
Excisional debridement procedures in the inpatient setting remain under intense scrutiny by Recovery Auditors, Medicare Administrative Contractors (MAC), CERT contractors, and other third-party payers given the high error rate associated with the ICD-9-CM Volume 3 procedure coding.
CMS highlighted this high error rate in the Volume 1, Issue 2 February 2011 Medicare Quarterly Provider Compliance Newsletter under Recovery Auditor Finding; Excisional Debridement—Incorrect Coding. Recovery Auditors found that hospitals incorrectly reported excisional debridement when the provider debrided the wound using autolytic, enzymatic, or mechanical (whirlpool) debridement. They should have reported non-excisional debridement. The Recovery Auditors focused on whether the physician’s documentation explicitly supported the assignment of excisional debridement (ICD-9-CM code 86.22) within a specific range of MS-DRGs.