Excisional Debridement Coding to the Furthest Layer

Procedure code assignment for excisional debridement has always been a focus area in coding audits.  The biggest concern is whether or not the debridement is truly excisional in nature, and if the documentation truly supports an excisional debridement. HIA has written a previous Coding Tip on determining nonexcisional vs excisional debridement.

Another problem area for coders is determining the proper ICD-10-PCS body part value for excisional debridement.  Errors in choosing the proper body part value can lead to incorrect procedure codes and thus incorrect DRG assignment and reimbursement.

What does the Official Guidelines for Coding and Reporting state?

ICD-10-PCS Guideline B3.5 – Overlapping body layers states:  “If the root operations Excision, Repair or Inspection are performed on overlapping layers of the musculoskeletal system, the body part specifying the deepest layer is coded. Example: Excisional debridement that includes skin and subcutaneous tissue and muscle is coded to the muscle body part.”

The above guideline states that only a code for the deepest layer of an excisional debridement is reported.  In this case, it is muscle.  It is understood that the layers above are included in this one code for excision of muscle.  The challenge for coders is to choose not only the  correct layer but also the correct body part. For example, if excisional debridement is performed on a left calf ulcer with excision down to and including muscle, what body part value would the coder choose?  The answer is “left lower leg muscle.”  Code 0KBT0ZZ, Excision of Left Lower Leg Muscle, Open Approach is correct.  It would be inappropriate to assign a code from the anatomical regions, such as 0YBB0ZZ, Excision of left lower extremity, open approach.

For more examples please refer to AHA Coding Clinic, Third Quarter 2015; Pages 3-8

References

AHA Coding Clinic, Third Quarter 2015; Pages 3-8
AHA Coding Clinic, First Quarter 2013 Pages: 15-17
ICD-10-PCS Official Guidelines for Coding and Reporting 2016