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General Surgery Coding Alert

Reader Question:

Dressing Changes

Published on Fri Mar 01, 2002

Question: A patient who had a thoracic aortic aneurysm (TAA) graft replacement in another state was sent to one of our local nursing homes for recovery. There, he developed a nasty wound infection that was initially thought to be necrotizing fasciitis. My surgeon's first encounter with this patient was to take him into surgery to perform incision and drainage (I&D) and debride the chest wound. He has seen the patient twice since then, cleaning the wound and changing the dressing, in the operating room, under conscious sedation both times. How should the dressing changes be reported?
     
South Dakota Subscriber

Answer: You need not be concerned that the dressing changes were not performed in the office. That would be important if your surgeon had performed the original procedure (the graft replacement). Since he only saw the patient afterward, that procedure's global package does not apply to him, so the original debridement should be reported using the appropriate musculoskeletal debridement code. The two subsequent dressing changes may both be billed separately using 15852 (Dressing change [for other than burns] under anesthesia [other than local]), because conscious sedation was administered to the patient.
 
Although Medicare and many private carriers do not pay for conscious sedation, 15852 is billable in this case because it is a general anesthetic. Modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) should be appended to 15852 on both claims because the dressing changes are performed during the 90-day global period of the debridement. In this situation, all subsequent dressing changes (or debridements) are staged because the infection being treated preceded the first debridement and, therefore, cannot be considered a complication of surgery.

  You Be the Coder and Reader Questions were answered by Marcella Bucknam, CPC,  a coding and reimbursement instructor at Clarkson College in Omaha, Neb., and a longtime general surgery coding specialist; M. Trayser Dunaway, MD, FACS, a general surgeon in private practice in Camden, S.C.; Elaine Elliott, CPC, a general surgery coding and reimbursement specialist in Jensen Beach, Fla.; Arlene Morrow, CPC, a coding, reimbursement and compliance specialist in Tampa, Fla.; Kathleen Mueller, RN, CPC, CCS-P, a general surgery coding and reimbursement specialist in Lenzburg, Ill.; and Cynthia Thompson, CPC, a coding and reimbursement specialist with Gates Moore, a healthcare consulting firm in Atlanta.

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