Debridements (again)

katysuegood@gmail.com

When looking at excisional debridements, if the provider states the debrided 'down to the.....(subQ, bone, fascia, etc)', is this what is coded as the deepest level or by saying 'down to', are we saying that we debrided the levels above this?

Also, if you have a complicated debridement with fasciotomy do you still just code the fasciotomy or is it possible to code both a fasciotomy and a debridement for a single procedure?

For ex:
I then opened up the fascia, performed a fasciotomy. The muscle underneath this did not bulge significantly and it was intact. I then made a longitudinal incision in the medial portion of the leg and also completed a fasciotomy to include the medial and posterior compartment. I did this by taking the Soleus off of the tibia. Again, there was a significant amount of dish watery material. This did extend up the fascial planes past the knee on the lateral leg and just at the knee joint on the medial leg. There was significant skin changes on the posterior calf. I did excise and debride using electrocautery in skin and subcutaneous tissues in this area. I also excised using electrocautery in skin and subcutaneous tissues on the lateral and medial portion of the incisions that I made.


Also, remind me to never offer to audit debridements again... ;-)

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

kerryseekircher

Hi Katy-
I like to make sure that it is clear in the documentation if we are 'down to AND through'. For example, the MD documents that he debrided down to bone-but did he get through muscle and stop at the bone? I have found on numerous occasions, that they have not debrided the bone, just muscle when queried for clarification.
The coding rule is to code only the deepest level and it would then be implied that the levels above were debrided as well.
Below is a mnemonic I developed to remember the elements needed to properly code a debridement: ) You are obviously an expert in this area, but it has been helpful in training new staff and we share it with the MD's as well.

This mnemonic TIDE is a helpful tool to assist in documenting an excisional debridement:
T: Type of tissue excised (necrotic, slough, etc..)
I: Instrument used for excision
Depth of tissue excised and if down to bleeding/healthy tissue
E: Excisional Debridement vs. Nonexcisional Debridement/Chemical Debridement

I am curious to see what others will reply, but my first thought is that you would not code another debridement in your scenario-just the fasciotomy.
Have fun with the rest of the audit! : )

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013

lsipos@monument.health

I spoke with my coders about this months ago, and to them; "down to / down to the level of" means NOT INCLUDIING the bone, fascia etc. That is how I read it as well.

Juli

kerryseekircher

I would just be careful about assuming because you may miss out on opportunity. Sometimes they have debrided bone and other times not-if it is not clear, we query.

Kerry Seekircher, RN, BSN, CCDS, CDIP
Documentation Specialist Supervisor
Northern Westchester Hospital
400 East Main Street
Mount Kisco, NY 10549
Email: kseekircher@nwhc.net
Phone: 914-666-1243
Fax: 914-666-1013