Knowledge Base Article

Q:

Would you please clarify guidelines for when it is appropriate to code excisional vs non-excisional debridement?

A:

One thing to keep in mind, is the difference between an excisional debridement and a non-excisional debridement. 

An excisional debridement:

• Is a surgical procedure that involves an excisional method of removal, or cutting away tissue, necrosis and/or slough
• Groups to a surgical MS-DRG
• Results in a higher relative weight
• Translates into higher reimbursement
• Is classified to root operation “Excision”

A non-excisional debridement:

• Non-operative procedure involving brushing, scrubbing, irrigating or washing of devitalized tissue, necrosis, slough, and/or foreign material.
• May be classified to root operation “Extraction” (pulling or stripping out or off all or portion of a body part by use of force)
• Use “Extraction” of the specific body part instead of “Irrigation” when coding for debridement of areas other than skin
• May be classified to root operation “Irrigation” when procedure is performed by irrigating the devitalized tissue
• Does not group to a surgical MS-DRG

As stated in 3rd Qtr. Coding Clinic 2015: pages 3-5, "the provider is not expected to use the terms used in PCS code descriptions, nor is the coder required to query the provider when the correlation between the documentation and the defined PCS term is clear.  It is the coder's responsibility to determine what the documentation equates to in the PCS definitions."   

When the physician’s intent of the procedure is to debride the wound, in most cases, he or she is not likely to use the PCS terms “Extraction, Irrigation or even Excisional”, as emphasized in the guideline above”   Documentation in the body of the procedure note should be descriptive enough for the coder to determine which procedure code to assign.

It should also be noted that this same Coding Clinic also emphasizes that a code is assigned for excisional debridement when the provider documents “excisional debridement” “AND / OR” the documentation meets the definition of the Excision root operation.  

Even when the physician states an excisional debridement was carried out; elements must also be documented in the body of the procedure note to support an excisional debridement.  You may find it easier to memorize “TINA D” in order to help with assignment of the more appropriate code for the procedure performed.

T - Technique used by the provider (cutting, scrubbing, trimming)

I - Instruments used (scissors, scalpel, pulse lavage, or curette)

N - Nature of the tissue removed (slough, necrosis, devitalized tissue, or non-viable tissue)

A - Appearance and size of the wound (fresh bleeding tissue or viable tissue)

D - Depth of the debridement (down to and including)

Additional things to remember:

1. Use of sharp instrument is not always indicative of excisional debridement.
2. Only one code, for the deepest layer documented is assigned when there are multiple layers involved of the same site
3. Both excisional and non-excisional debridement can be performed by:

• Physician
• Physician assistant
• Nurses
• Therapists

4. The location in which the procedure is performed is no indication of the type of debridement carried out.

Remember:  We cannot assume anything.  Documentation in the record needs to clearly support and reflect the procedure that was performed.   If not, then a query should be sent for clarification.