Debridement vs. excision?


Athens, OH
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I am coding for a Wound Care surgeon and Im stumped as to what direction to go with this op report. The part that Im stuck on is in blue.

He states:

Wound 1- pre op 1.5x1.5x0.2, post op 2.0x1.5x0.5
Wound 2-pre op 1.5x2.0x0.1, post op 3.5x15.x0.5.

Preoperative Dx: Chronic wounds to right leg status post radiation to right leg secondary to BCC.

Procedure: The wound measurements were taken and then the wounds were debrided with a curett, #2 and 3 curettes were used. Then also sharp debridement with 15 blade and pickup was done. Initially the base of the wounds were curetted. These were all fibrous necrotic tissue that was yellowish and whitish in color that was excised suing 15 blade and Metz. Both wounds are debrided.
Wound 2 the most superior part of it, there was a small wound that I was concerned about being possible BCC and this was excised and sent for pathology.

Both wounds were then loosely approximated with 2-0 Nylon. (the remainder of the note regards dressings and wound care only)

The pathology on the "excised" portion came back as invasive SCC.

My concern is that both of the wounds underwent sharp debridement, just one portion was sent of that came back as SCC.

Any input would be very helpful.
Milwaukee WI
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Two surgical sites

Based on the information given ....

I would code the appropriate wound care (sorry don't have CPT handy) for Wound # 1, and the excision of malignant lesion for wound # 2. You'll need a -59 modifier to notify the payer that these are two distinct surgical sites.

Hope that helps.

F Tessa Bartels, CPC, CEMC