General Surgery Coding Alert

Question: What is the CPT code for radical debridement of the lower abdominal wall, including anterior fascia of the rectus abdominis muscle, fistulogram and drainage, and antibiotic irrigation and packing? The diagnosis was acute necrotizing fasciitis of the abdominal wall.

Anonymous California Subscriber

Answer: Typically, debridements are coded 11040-11044 when they are for skin and/or muscle. In the situation described by the reader in which the wound is so large, however, the debridement is much more complex than these codes allow, says Karen Evans, RN, CPC, CCS-P, a coding and reimbursement specialist in Mount Vernon, Wash. She suggests using unlisted procedure code 22999 (unlisted procedure, abdomen, musculoskeletal system). This code reflects the fact that necrotizing fasciitis puts the patient at high risk, but it also accurately shows that the surgeon did not actually enter the abdominal cavity.

Evans says that when billing the procedure, the physician should put a value on it and send an operative note along with a cover letter detailing what was involved in the procedure and why it was performed. She notes that unlisted codes should never be sent electronically. The fistulogram and the antibiotic irrigation and packing are part of most procedure codes; therefore no extra billing for these services applies, Evans says.