Coding Debridement Procedures


Vol. 18 • Issue 22 • Page 9
Coding Corner

Preoperative and Postoperative Diagnoses: Open wound, right knee

Procedure performed: Debridement of the right knee with placement of an Integra graft approximately 12 sq cm

Anesthesia: General

Indication: This is a 69-year-old female who is status post right total knee replacement. She developed a fairly large necrotic area that was debrided earlier. She presents today for debridement and placement of Integra graft.

Procedure Description: The patient was seen and evaluated in the preoperative holding area and taken back to the OR where she was placed in a supine position. Next, she underwent general anesthesia and was subsequently prepped and draped in a sterile fashion.

Next, we debrided the anterior knee wound using a Norsen debrider, curette and scalpels. Hemostasis was achieved via the Bovie. Two deep stitches were placed to help reapproximate the deeper tissues. The knee joint capsule was not violated. Following this, we then placed an Integra graft approximately 12 sq cm over our debrided wound. Next, the Integra was tacked down with simple and running sutures of 3-0 chromic.

The patient tolerated the procedure well and was transferred to the recovery room in stable condition.

ICD-9-CM DIAGNOSIS CODES

998.83 Non-healing surgical wound

ICD-9-CM PROCEDURE CODES

86.67 Dermal regenerative graft

CPT PROCEDURE CODES

15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar, (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms or legs; first 100 sq cm or 1% of body area of infants and children

15170 Acellular dermal replacement, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children.

CODING RATIONALE

The physician documented (under the “indication” section) that the patient had a previous right knee replacement. The wound has not healed appropriately, and, therefore, the patient is coming in for a skin graft placement.

In the CPT index, there are two sections related to procedures of this type. One is Skin, and the other is Skin Graft and Flap. In your code assignments, you will choose codes from each section.

First, under Skin, find the word Grafts, then Free . 15050-15321, 15340-15366, 15420-15431, 15757. A review of the descriptions will lead you to the choice indicated above-15002.

As indicated in the boldface type in the case study, the physician debrided the wound. Debridement describes prolonged cleansing of contaminated tissue. All dead or foreign material is removed, tissues are irrigated and the wound site is explored to identify neurovascular, ligamentous or tendinous injury and to control hemorrhage.

CPT code 15002 describes the debridement of the ulcer of the knee prior to the skin graft placement. The physician documented that the graft is 12 sq cm. Assign code 15002 for this preparation of the wound prior to the skin graft being placed.

Once the area was debrided, an Integra graft (an acellular dermal skin replacement) was placed. Review the entries under Skin Graft and Flap, where you will see an entry for Recipient Site Preparation . 15002-15005. Again review the descriptions of the codes listed. CPT code 15170 describes that procedure performed. n

Peggy Hapner is manager of the HIM consulting division at Medical Learning Inc. (MedLearn), St. Paul, MN.

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