Debridement/ORIF
I hope everyone had a great thanksgiving!
I actually posed a similar question a little while back and never got a response. Fingers crossed this time J
We have a new coder on our team that is repeatedly asking for queries regarding debridement’s performed as part of an ORIF. She is requesting this based on the Coding Clinic Q42014p32
ICD-10-CM/PCS Coding Clinic, Fourth Quarter ICD-10 2014 Pages: 32-33 Effective with discharges: December 31, 2014
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. For the ORIF of the fractures and manipulation of the dislocation, assign the following ICD-10-PCS codes:
Based on this she is asking for a query basically any time the physician states he/she debrided.
For example:
Op note: "Displaced fracture became readily apparent. The fracture was further exposed. The hematoma was débrided; periosteum along the fracture edge was removed. The articular surface was visualized. The joint was irrigated, as was the fracture. The fracture was reduced".
Op note: “I then identified the fracture, cleared it of the fracture hematoma, removed any devitalized tissue with a knife and curette. I saw no evidence of contamination.”
I have asked a couple other coders and they said they would just code the ORIF, no query. But I am having a hard time justifying this with the coder since she does have this coding clinic to reference and I have….nothing.
Anyone else having similar issues or have any guidance?
Thanks!
Katy
Comments
Appears that the debridement is inherent to the procedure, is that what she's asking in her queries? Does it change the DRG since they are already having operative intervention? Not any help but you've sparked my curiosity!
Jeff
yes jeff. I also think these are inherent. But she is citing the coding clinic as reason why we need to clarify (inherent or not) anytime a debridement is documented on the OP note of an ORIF.
Katy
I don't see 'if unclear' in the coding clinic? The example in the coding clinic I would not have expected to require a query either.
To me the coding clinic does seem to imply that we need the reason specified. I, of course, find this problematic too. But I am having a hard time mounting a defense in light of this coding clinic.
Katy
In my view the key issue is "how many separate anatomical sites may have been separately debrided"?
Paul
Betty
Jeff is spot on. I believe we all agree Best Practice is to ask a query only when warranted, and I'd think that the need to query w/ ORIF would be the exception to the rule. (Query Fatigue always a concern).
Paul
Yes..well, obviously coding and CDI should work in harmony on such issues lest the MD become irritated with needless queries. I have coded more than a 'lot' of such cases, and can state anecdotally that I typically see debridement carried out only as an integral portion of the ORIF and rarely qualifies as a separate code.
Paul Evans, RHIA, CCDS