Iirrigation=Debridment?

Cheri CPC

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I hope someone can help me with this,,,

If the surgeon documents "irrigation" of multiple gunshot wounds in the OR, not related to the primary surgery, how would you code this? He doesn't document removal of tissue, just irrigation, left open and dressed. He coded 11012, would this be correct? I cannot find any code for just irrigation, would this be coded with an unlisted procedure?? The primary procedure was nailing of the femur,,, gunshot wounds multiple on legs and hand, all irrigated.

Help!
Thanks, Cheri
 

amolson1325

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I hope someone can help me with this,,,

If the surgeon documents "irrigation" of multiple gunshot wounds in the OR, not related to the primary surgery, how would you code this? He doesn't document removal of tissue, just irrigation, left open and dressed. He coded 11012, would this be correct? I cannot find any code for just irrigation, would this be coded with an unlisted procedure?? The primary procedure was nailing of the femur,,, gunshot wounds multiple on legs and hand, all irrigated.

Help!
Thanks, Cheri
Hi Cheri,

I think that 11012 would be correct. I searched around and came across a few different definitions but one did say "debridement is cleansing of or removal of dead tissue from a wound.

Hope that helps!!:)
 
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Irrigation isn't exploration

Mary - I'm not sure that 20100-03 would fit ... Cheri's posting seems to imply that the MD is only stating "irrigation," hence the problem.

If that's truly all he states in terms of documentation then he couldn't bill 11012 either (he has to specify that he was down to bone).

I do think you're on the right track in terms of where in CPT we should be looking, but I think the documentation doesn't support any of these codes.
He's leaving money on the table (no pun intended) by not being clear as to what was performed.

Cheri should show the doc the description of 20100-03 and help educate him/her about how to document ... if there were multiple gunshot wounds and they were adequately documented, it might be possible to use several of these codes in addition to the major surgical procedure.

F Tessa Bartels, CPC, CPC-E/M
 

Cheri CPC

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Thanks, this is exactly my dilemma,,,, no where is it stated tissue, bone, anything removed, just irrigated and dressed. Everything I've researched says "irrigation" is a bundle with E/M but how do you bill E/M in the OR???? Also documents "multiple" but doesn't number them or describe exact location other than the hand. I just wanted to make sure I was not missing anything! I also had looked at the exploration codes before I posted, and it doesn't fit, he didn't look around, didn't extend the wound- op note as follows:

"The multiple gunshot wounds were irrigated in the operating room. Gunshot wounds were not closed surgically and were only dressed sterilely and allowed to drain. Please note that the patient has gunshot wounds to his hand and hand service has been consulted, however during this trip to the operating room these wounds were also irrigated copiously and sterile dressings applied"

All of which were unrelated to the nailing of femur! Would it be appropriate to add -22 to the procedure?
 

amolson1325

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Hi Cheri,

I don't think -22 would be appropriate because that is an increase in service that wasn't planned for that service. Like if the nailing of the femur took a lot more time and work than anticipated.

I think you would need a -59 to indicate that the irrigation (debridement) of the gunshot wounds were done in addition to the femur nailing during the same operative session.

I hope that answers your question.
 
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Is he willing to dictate an addendum?

Cheri,
I agree that mod -22 is NOT applicable ... it should be used only to show that a particular procedure was more extensive, not to compensate for additional procedures that were performed but not adequately documented.

Would your doc be willing to dictate an addendum to support the additional procedures performed? Show him the descriptions of the 11010-12 (specific for debridement associated with open fracture), vs 11040-44, vs 20100-03.
Let him know that his documentation doesn't currently support the 11012 he coded, and ask if he'd like to dictate an addendum. If there are multiple wounds, he could potentially bill for each wound. But they have to be clearly documented.

Good luck ... let us know how it works out.

F Tessa Bartels, CPC, CPC-E/M
 

Cheri CPC

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I just can't do the 11012 without documentation of removal of bone.

The surgery was over a month ago,,,, I'll "suggest" an addendum, but at this point.... I think its more of a "learning curve"


Thanks!
Cheri
 

amolson1325

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Can't you use 11011, that excludes the bone, since he didn't document the bone??

Or 11043 since he just said he irrigated the wounds and didn't seem to mention removing foreign material either, that code to me would be more appropriate since it's just for debridement??? Unless I'm misunderstanding, he is placing the 11012 with the gunshot wounds right?
 
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