Excisional Debridement

ddraize

Does any one know where I can find a reference for coding excisional debridement? I have a surgeon who does not want to document the type of instrument used, unless I can show him in writing. I do have one article by AHIMA. Thanks

Diane Draize RN, CPUR,CCDS
Clinical Documentation Specialist
Ministry Door County Medical Center
diane.draize@ministryhealth.org
920-743-5566 ex 3143

We earn trust by working together as One Ministry to keep PATIENTS FIRST in everything we do

stacy.vaughn

Excisional debridement is the surgical removal or cutting away of
devitalized tissue, necrosis, or slough. Depending on circumstances such
as the patient's condition, availability of a surgical suite, or extent of
area to be debrided, excisional debridement can be performed in the
operating room, emergency room, or at the patient's bedside.

For coding purposes, excisional debridement, 86.22, is assigned only when
the procedure is performed by a physician.

Nonexcisional debridement is the nonoperative brushing, irrigating,
scrubbing, or washing of devitalized tissue, necrosis, or slough.
Nonexcisional debridement includes snipping of tissue followed by Hubbard
tank therapy. Nonexcisional debridement may be performed by a nurse,
therapist, or physician.

For coding purposes, nonexcisional debridement performed by the physician
or nonphysician health care professional is assigned to 86.28. Any
"excisional" type procedure performed by a nonphysician is assigned to
86.28

4Q 1988

Stacy Vaughn, RHIT, CCS, CCDS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052

kristen.anderson

Here is a coding clinic I found. I have also attached a Best Practice reference that we use to educate physicians.

Debridement - guideline
Coding Clinic 3rd Qtr. 1991, pp. 18-19

Question:
We need further clarification on the distinction between excisional and nonexcisional debridement, as the lack of clear-cut guidelines is resulting in these codes being misapplied. Since the existing guideline states that 86.22 is assigned when the procedure is performed by a physician, some hospitals are using 86.22, Excisional debridement, whenever the physician performs a debridement procedure. Medical record documentation is often vague as to how the debridement was performed.

Answer:
First, this quotation of the guideline is not accurate (see Coding Clinic, 4th Qtr. 1988, p. 5). The information previously published indicated that only the physician can perform an excisional debridement, not that all debridements performed by a physician would qualify as excisional. Unless the attending physician documents in the medical record that an excisional debridement was performed (definite cutting away of tissue, not the minor scissors removal of loose fragments), debridement of the skin should be coded to 86.28, Nonexcisional debridement of skin, as the index directs. Any debridement of the skin that does not meet the criteria as noted above or is described in the medical record as debridement and no other information is available, should be coded 86.28, Nonexcisional debridement. Note that other codes are provided for debridement of organs or tissue other than skin. Debridement of the skin that is preparatory to further surgery such as reduction of fracture, etc., should not be coded as a separate procedure.

Code Update: As of October 1, 2000, escharotomy is re-indexed to code 86.09. See Coding Clinic 4th Qtr. 2000, p. 68.




Kristen Anderson MSN, RN
Clinical Documentation Specialist
Metro Health Hospital
Phone: (616) 252-7534
Email: kristen.anderson@metrogr.org

lspryszak

Thanks for the nice reference!