Four Question to Guide your Ucler Reporting

Four Question to Guide your Ucler Reporting

When your dermatologist carries out a decubitus ulcer excision or debridement, you will have to choose from about 25 possible codes. If you ask yourself the following four questions about the excision and debridement services, you will have an easier time selecting the right code.

Was the wound closed? If yes, by what method? In some instances, the dermatologist may debride the ulcer and allow the wound to stay open to heal. On the other hand, the dermatologist may excise the ulcer, clear all infection, and close the wound. The difference: You shouldn't distinguish debridement from excision by the ulcer's removal but, rather, by what the documentation specifies. For instance, documentation for an ulcer removal may read, "The skin was cut in elliptical fashion around the lesion, and the dermatologist excised and sent the lesion to pathology. The dermatolgist closed the wound with 4-0 sutures in a layered fashion (or packed open to drain and heal by secondary intention)." It's difficult to tell the difference sometimes (both methods are ways of clearing infection); as such you should determine your coding on what the dermatologist describes in the documentation.

Where was the ulcer? With the nine ICD-9 codes for decubitus ulcers (707.00-707.09), you may have many codes to select from, specific to the ulcer's location on the body:

707.00 -- Pressure ulcer; unspecified site

707.01 -- elbow

707.02 -- upper back

707.03 -- lower back

707.04 -- hip

707.05 -- buttock

707.06 -- ankle

707.07 -- heel

707.09 -- other site.

How deep was the debridement? You can report debridement (11040-11044) based on three different skin levels, which are partial thickness, full thickness or subcutaneous or as deep as muscle or even bone. For instance, 11044 (Debridement; skin, subcutaneous tissue, muscle, and bone) describes a debridement that involves chipping off pieces of diseased bone to help rid the wound of infection. A partial thickness debridement includes the epidermis and part of the dermis; however some dermal cells are left. The physician normally carries out these procedures using a scalpel or scissors, depending on the situation.

Besides the ulcer, was anything else excised? In some cases, with coccygeal pressure sores the dermatologist may remove the coccyx to do away with irritation and prevent the ulcer from recurring. The dermatologist may also excise bony prominences as a pressure sore at the same time.

Was anything else excised besides the ulcer? In some instances, with coccygeal pressure sores the dermatologist may remove the coccyx to eliminate irritation and prevent the ulcer from recurring. The dermatologist may also excise bony prominences at the same time as a pressure sore. For more on this and other dermatology coding updates, sign up for a medical coding guide like Supercoder!

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