ED Coding and Reimbursement Alert

Question: A patient with chronic venous insufficiency without varicosity reports to the emergency department (ED) with venous stasis ulcers on the right and left calves. Both ulcers are limited to a breakdown of the skin. The left calf ulcer is 100 sq cm and the right calf ulcer measures 16 sq cm. The ED physician used a high-pressure waterjet to debride 100 percent of the wound surface of both ulcers. Notes indicate that the physician removed “slough, biofilm, dermis, and epidermis.” How should I report this encounter?

Tennessee Subscriber

Answer: You’ll report a total of six procedure codes and three ICD-10-CM codes. One of those procedure codes will be repeated five times, so the coding isn’t as daunting as it might seem.

On the claim, report the following:

• 97597 (Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less) for the initial 20 sq cm of debridement, which leaves you with 96 sq cm of debridement to code for
• +97598 (… each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)) x 5 for the remaining 96 sq cm of debridement
• I87.2 (Venous insufficiency (chronic) (peripheral)) appended to 97597 and +97598 to represent the venous insufficiency
• L97.221 (Non-pressure chronic ulcer of left calf limited to breakdown of skin) appended to 94597 and +97598 to represent the left calf ulcer
• L97.211 (Non-pressure chronic ulcer of right calf limited to breakdown of skin) appended to 94597 and +97598 to represent the right calf ulcer

With this combination of codes, you’ll cover all 116 sq cm the physician debrided as well as the stasis ulcers of both calves.

Gena Cornett, CPC, CPB, CPCO, CRCR, RCMS, CPB-I,
and Chris Boucher, MS, CPC, Senior Development Editor, AAPC