Wiki Excision Necrotic Tissue Exterior of Bladder/Peritoneal Reflection

[Crawlspace324]

This is a new one for me and I'm lost for exactly how to code it.

Urologist does an open debridement of necrotic tissue found on the exterior of the bladder and the peritoneal reflection. Bladder was irrigated and small clots cleared. No leaks or masses are noted, so he elects not to open the bladder. No cystoscopy is performed. Debridement is performed on the infected, necrotic area of the right lateral bladder wall and the peritoneal reflection. Original source and etiology are unclear. All necrotic tissue was debrided, the area washed out, two drains placed.

Do I go with debridement codes? The only thing I've come close to that doesn't involve cystoscopy/the interior of the bladder is 11043.

Any help or thoughts would be appreciated.

 

[meghanhannus]

open debridement of necrotic tissue found on the exterior of the bladder and the peri

This is a new one for me and I'm lost for exactly how to code it.

Urologist does an open debridement of necrotic tissue found on the exterior of the bladder and the peritoneal reflection. Bladder was irrigated and small clots cleared. No leaks or masses are noted, so he elects not to open the bladder. No cystoscopy is performed. Debridement is performed on the infected, necrotic area of the right lateral bladder wall and the peritoneal reflection. Original source and etiology are unclear. All necrotic tissue was debrided, the area washed out, two drains placed.

Do I go with debridement codes? The only thing I've come close to that doesn't involve cystoscopy/the interior of the bladder is 11043.

Any help or thoughts would be appreciated.

Hello Crawlspace324,

This is an interesting one Is the provider incising through skin and cutting down through muscle, fat and fascia? Also was there closure to the incision or just two drains placed?? I am thinking that since the right lateral bladder wall is part of the bladder that we should stay away from using the integumentary system code (s) and go with urinary system code (s). Unfortunately, maybe unlisted CPT 53899 or CPT 51550 (also can use as comparable code to the unlisted)? And CPT 51700 for bladder irrgation? There aren't any edits for these codes when billed together.

CPT 51550- The physician removes a portion of diseased or damaged bladder tissue. To access the bladder, the physician makes an incision in the skin above the pubic bone and cuts the corresponding muscles, fat, and fibrous membranes (fascia). The physician mobilizes the bladder and the major vesical blood vessels, and incises the bladder wall to access the diseased or damaged bladder tissue. After removing the tissue, the physician inserts catheters into the bladder and urethra and sutures the bladder tissues. The physician performs a layered closure and inserts a drain tube, bringing it out through a separate stab incision in the skin.

CPT 51700- The physician initially places the catheter into the bladder and irrigates by hand until the bladder is free of clots or debris.

Hope this helps

M.Hannus, CPC, CPMA, CRC