General Surgery Coding Alert

As many as 25 codes can describe the excision or debridement of a decubitus ulcer. To select the appropriate code, general surgery coders must understand the difference between an excision and a debridement. In addition, the following questions must be answered:

(1) Was the wound closed and, if so, by what method?
(2) Where was the ulcer located?
(3) How deep was the debridement (if performed)?
(4) Was anything else excised besides the ulcer?

Note: The coders ability to answer these questions depends largely on the quality and specificity of documentation in the operative report.

Choosing Excision or Debridement

Decubitus ulcers (also known as bedsores, pressure sores and pressure ulcers) occur because of local interference with circulation, and usually appear over a bony prominence at the sacrum, hip (trochanter), heel, shoulder or elbow.

Typically, a general surgeon will treat decubitus ulcers when structures underlying the external lesion are affected. In some cases the surgeon may debride the ulcer effectively removing it and allow the wound to stay open to heal. Alternately, the surgeon may excise the ulcer, clear all infection and close the wound. Debridement is not differentiated from an excision by the ulcers removal but, rather, by the fact that the wound has been cleared of infection and closed.

According to M. Trayser Dunaway, MD, a general surgeon in Camden, S.C., if infection is present and the wound is left open to heal, a debridement code (11040-11044) should be used. If, however, the wound is free of infection and closed by either sutures or flaps (or, in some cases, preparation of the wound for closure at a later date), the pressure sore is considered excised and the appropriate code from the decubitus ulcer category (15920-15999) should be used. Surgeons will close a repair only if there is no longer any sign of infection, stresses Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill. An excision is performed only after the wound has healed. Thats when codes 15920-15999 come into play, she explains.

Selecting the Correct Excision Code

Excision codes describe four types of pressure ulcers (coccygeal, sacral, ischial and trochanteric) that are differentiated by location, with the exception of 15999 (unlisted procedure, excision pressure ulcer). In addition, at least two codes describe each type of pressure sore excision the first describes closure by primary suture, and a second designates closure with skin flaps. For example, if a sacral decubitus ulcer is excised and the repair is closed with sutures, 15931 (excision, sacral pressure ulcer, with primary [...]