debridements and ORIF

katysuegood@gmail.comkatysuegood@gmail.com
in Clinical & Coding

in I-10 we have a the coding clinic that advises to query when ORIF and debridement is performed for intent of debridement if its unclear.

Coding Clinic, Fourth Quarter 2014: Page 32

Question:

A patient diagnosed with open forearm fracture of both bones and closed distal radioulnar joint dislocation underwent open reduction with internal fixation (ORIF) of the forearm bones, and manipulation of the dislocation. The provider documented that the wounds over the ulnar shaft were irrigated and debrided down to the bone. The ORIF and dislocation manipulation were then completed. Would it be appropriate to assign a code for the debridement in addition to the code for the ORIF and the manipulation?

Answer:

Query the physician as to the specific location and reason for the debridement (whether a separate excisional debridement versus cleaning of the open wound was done). If irrigation and debridement were done to clean the wound as part of the open reduction internal fixation (ORIF), it would not be separately coded.

we have one coder who feels like this means we need to query every time a debridement is performed in these cases. Other coders seem to only feel a query is necessary if they believe there is evidence of another reason to perform debridement (outside of cleaning). We currently have a case where the patient had 2 procedures after an open humerus fx. Initially they did a debridement and placed a external fixator:

POSTOPERATIVE DIAGNOSES: 

  1. Left grade 2 open distal humerus fracture

  2. Ruptured left biceps tendon.

     PROCEDURE: 

  1. Irrigation and excisional debridement of left grade 2 open distal humerus fracture. This was an excisional debridement of skin, subcutaneous tissue, fat, fascia, muscle and bone utilizing scalpel, scissors and curettes.

  2. Placement of spanning external fixator, left elbow.

  3. Repair of 5 cm of laceration. 

2 days later, they did another debridement and an ORIF:

POSTOPERATIVE DIAGNOSES: 

  1. Open distal humerus fracture.

  2. Distal biceps tendon rupture and avulsion.

     OPERATIONS PERFORMED: 

  1. Removal of external fixator.

  2. Irrigation and débridement of an open humerus fracture down to the level of bone with removal of subcutaneous fat and muscle with use of a knife and curette, no bone was removed.

  3. Open reduction internal fixation of humeral shaft fracture.

  4. Distal Biceps Tendon repair


Do you understand there to be queries needed for BOTH procedures, Just the ORIF, or none?


thanks!


Katy

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