Graft closure
Alright experienced coders, I have some questions. I am mid-audit for PEPPER but am getting hung up on some coding stuff that is not really the purpose of my audit (of course!!). Pt had a R transmetatarsal amputation 2 months ago for DM related soft tissue infection and has had a wound vac in place. Pt then comes in for scheduled skin graft. Documentation in H&P states "Right TMA with no sign of tunneling wound or infection, now with area of granulation tissue on both distal foot and heel. Ready for STSG to area to speed healing process and lead to initiation of physical therapy and mobility training with prosthesis."
This is what the coder coded:
Pdx 997.69 (stump complication)
Sdx 250.02 9DM)
Ppx 86.69 (skin graft)
This puts us in DRG 465 (graft for musculo-conn tissue disease)
I thought this qualifies for a coding scenario described in this coding clinic:
Delayed closure of amputation site with skin graft
Coding Clinic, Fourth Quarter 1999 Page: 15 Effective with discharges: November 15, 1999
Related Information
Question:
A patient who is status post open transmetatarsal amputation of the right foot is readmitted for delayed closure of the amputation site. 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. Should code 84.3, Revision of amputation stump (includes secondary closure of the stump) be assigned or would code 86.69, Other skin graft to other sites, be more appropriate for the graft closure of the amputation site?
Answer:
Note from 3M:
As of October 1 2000, Code 707.1 has been expanded to the fifth digit level to indicate specific sites of the lower extremity.
Assign code V58.41, Encounter for planned postoperative wound closure, as the principal diagnosis. Code 707.1, Ulcer of lower limbs, except decubitus, may be assigned as a secondary diagnosis. 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.
What would you do????
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
This is what the coder coded:
Pdx 997.69 (stump complication)
Sdx 250.02 9DM)
Ppx 86.69 (skin graft)
This puts us in DRG 465 (graft for musculo-conn tissue disease)
I thought this qualifies for a coding scenario described in this coding clinic:
Delayed closure of amputation site with skin graft
Coding Clinic, Fourth Quarter 1999 Page: 15 Effective with discharges: November 15, 1999
Related Information
Question:
A patient who is status post open transmetatarsal amputation of the right foot is readmitted for delayed closure of the amputation site. 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. Should code 84.3, Revision of amputation stump (includes secondary closure of the stump) be assigned or would code 86.69, Other skin graft to other sites, be more appropriate for the graft closure of the amputation site?
Answer:
Note from 3M:
As of October 1 2000, Code 707.1 has been expanded to the fifth digit level to indicate specific sites of the lower extremity.
Assign code V58.41, Encounter for planned postoperative wound closure, as the principal diagnosis. Code 707.1, Ulcer of lower limbs, except decubitus, may be assigned as a secondary diagnosis. 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.
What would you do????
Thanks!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Comments
Judy
Judy Riley, RHIT, CCS
Manager of Clinical Documentation Improvement and Coding
LRGHealthcare
AHIMA Approved ICD10-CM/PCS Trainer
jriley@lrgh.org
We do have that the DM is uncontrolled but our documentation of complications of the DM could have been better. I appreciate your response!
Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404
Judy
Judy Riley
Coding/CDI Mgr
x 3315