Not All Debridements Are Excisional
Recovery audit contractors (RACs) have recouped millions of dollars for excisional debridements that weren’t really excisional, or that weren’t fully documented to support the coding reported. In CPT® terms, think of the skin debridement codes in the 10000 section as excisional, and the debridement codes found in the 90000 section as non-excisional.
As explained in the February 2011 Medicare Quarterly Provider Compliance Newsletter, providers have been found to “incorrectly reporting excisional debridement when the wound is debrided using autolytic, enzymatic, or mechanical (whirlpool) debridement.”
Merely trimming up skin fragments around the wound edges is not invasive enough to count as excisional debridement. Per CMS, “Excisional debridement of wound, infection, or burn is defined as the surgical removal or cutting away of devitalized tissue, necrosis, or slough.” The first quarter 2004 Coding Clinic further defined excisional debridement to involve cutting outside or beyond the wound margin to remove devitalized tissue. Documentation should clearly indicate that the procedure involves cutting outside or beyond the wound margin. The tools used to remove any devitalized or necrotic tissues should be specifically listed. Auditors look to see if the provider used scissors or a scalpel and whether they removed just the fragments around the wound edges or excised non-viable tissues down to and including “X level” of healthy tissue.
If documentation includes ambiguous detail such as “wound was debrided to normal bleeding tissue” or “bleeding was observed,” the coder may need to query the physician to clarify the procedure that was performed.