Debridement Coding in ICD-10-PCS

1 Coding Debridement Coding in ICD-10-PCS . CONQUER THE CHALLENGE. by Me lissa Shilling , M S , C D I P, C C S , C P C. Coding for excisional and non- autolytic, biologic, enzymatic or other stripping out or off all or part of a body excisional Debridement procedures means. part by use of force.. is likely to continue to be under n T h e s u r g i c a l d e b r i d e m e n t The selection of the type of Debridement the microscope. This has been a target area for the Revenue Audit method is coded as an excisional requires specific documentation Contractor (RAC) and other auditors Debridement , given sufficient from the physician or other health because Debridement procedures are provider documentation. care providers who performed the frequently miscoded. All too often, an procedure.

2 An excisional Debridement n The mechanical Debridement excisional Debridement is coded when is coded when the health care provider methods are coded as a non-surgical documents excisional Debridement ;. the documentation supports only a Debridement and include washing, non-excisional Debridement . There is this is often referred to as the magic brushing or using hydrosurgery. The words by Coding professionals. But a significant difference in the relative Versajet system is a hydrosurgery weights of an excisional compared even without the magic words, if Debridement method; a high the procedure documentation meets to a non-excisional Debridement ; the velocity stream of fluid produces a former groups it to a surgical Diagnosis the definition of the root operation local vacuum, the Venturi effect, Excision (cutting out or off, without Related Group (DRG) and the latter to which removes the dead tissue.)

3 A medical DRG. The implementation of replacement, part of a body part), ICD-10 did not make the challenge of Debridement is broadly classified as then it is still coded as an excisional distinguishing between an excisional either excisional or non-excisional. The Debridement . Convention A11 of the and a non-excisional Debridement code term Debridement in the alphabetic ICD-10-PCS Official Coding Guidelines disappear. The purpose of this article index of ICD-10-PCS Official Coding specifies that, it is the coder's is to provide information that may be Guidelines lists: responsibility to determine what the helpful when selecting the correct documentation in the medical record n Debridement , excisional as the root equates to in the PCS definitions (CMS, ICD-10-PCS code for a Debridement operation Excision; and procedure.

4 2016). n Debridement , non-excisional as Guideline of the ICD-10- Debridement is the removal of root operation Extraction. devitalized tissue to encourage wound PCS Guidelines instructs Coding healing and to reduce the likelihood The definition of the root operation professionals to code only the deepest of infection. Two specific types of Excision is the cutting out or off, layer when multiple layers are involved devitalized tissue include slough without replacement, a portion of a (CMS, 2016). So, it is important for the and eschar. Devitalized tissue can body part. The definition of the root documentation to indicate the deepest be removed by surgical, mechanical, operation Extraction is the pulling or layer of tissue removed. The Coding 12 CHIA JOURNAL NOVEMBER / DECEMBER 2017.

5 Debridement Coding in ICD-10-PCS . professional cannot assume that bone was debrided just because the lab TERM DEFINITION. report mentions bone fragments. Devitalized Tissue that is avascular (dead, necrotic, nonviable). I t i s n o t a p p ro p r i a t e t o m a ke Granulated Tissue that often has a rough or grainy texture and red assumptions when selecting a or pink color. This moist tissue appears early during Debridement code. For example, the wound healing. Coding professional cannot assume that an excisional Debridement was Slough Devitalized tissue that is often white or yellow in color, performed based on documentation but could be tan or green. of the use of sharp scissors to Eschar Devitalized tissue that is most often brown or black remove devitalized tissue or other in color.

6 Nonspecific terminology, such as sharp Debridement . When the documentation is unclear, the Coding professional must query the provider emergency department, the operating system with physicians cosigning the for clarification. room, or patient's room. Because wound care document. Coding professionals needs specific procedures may be done by nurses or other wound care specialists, not Coding wound Debridement and detailed information to identify only by surgeons and other physicians, procedures in ICD-10-PCS can be a a n d c o d e t h e m o re re s o u rc e - Debridement documentation can be challenge. Reviewing the ICD-10-PCS . intensive excisional Debridement . The located in nursing or wound care Official Coding Guidelines and reading Debridement documentation should notes.

7 EHRs that separate nursing the American Hospital Association's include: documentation from physician AHA Coding Clinic for additional n Anatomical site (including laterality) documentation can be problematic, guidance helps to refresh Coding for example, the wound care nurse knowledge. Coding professionals n Type of Debridement (excisional or may find it worthwhile to review how non-excisional) documentation can be included in the record after the physician has signed the procedure is being documented n Technique used to remove the off on the record. The record should by their providers and to ask for tissue (scrubbing, cutting, irrigation) be locked to prevent the addition of help remediating documentation documentation after the physician has deficiencies. When the documentation n Instruments used (scalpel, wire, provides the necessary elements completed the record.)

8 Brush, scissors) for Coding , Coding professionals Another concern is conflicting will likely find that they are able to n Nature of tissue being removed documentation, for example, the conquer Debridement procedure (devitalized, necrotic, eschar, nurse describes a stage II pressure Coding challenges. slough). ulcer but the physician does not n Appearance and size of the wound document any skin integrity issue, (wound bed moist and red) or the nurse describes a wound as necrotic and the physician describes References n Depth of the procedure (removed the same wound as having slough. Brodie, S. (2016, January). Coding Clinic necrotic muscle tissue down to the It is important to have a process for CDI: Reassessing Debridement bone) documentation. Retrieved from hcpro. for consistent documentation; for com/HOM-324142-5728/ Coding -Clinic- When Clinical Documentation best practice, the physician should for-CDIR eassessing- Debridement - Improvement (CDI) education review the nursing wound care specialist Sharme Brodie teaches documentation.

9 If the physician does Centers for Medicare and Medicaid new CDI specialists the documentation not document an ulcer or other skin Services (CMS). (2016, August). ICD- requirements for Debridement , she integrity issue, then a pressure ulcer 10-PCS Official Guidelines for Coding suggests the mnemonic device stage III or higher could be coded as and Reporting 2017. Retrieved from not present upon admission. It may be TINA D, which stands for technique, Downloads/2017-Official- ICD-10-PCS - i n s t r u m e n t , n a t u re o f t i s s u e , possible to have the wound evaluation appearance and depth (Brodie, 2016). and treatment documented by the wound care specialist crossover The electronic health record (EHR) for inclusion in the physician's Melissa Shilling, MS, CDIP, CCS, CPC.

10 Can create challenges for Coding documentation, pending review and Member, CHIA Coding & Data Quality professionals because Debridement agreement. Many hospitals have Committee, 2016-2017. procedures can be performed in the instituted such a documentation 13.