need help with coding cpt code for debridement of necrotizing faciitis

barengland

Contributor
Messages
17
Location
Austin, Texas
Best answers
0
Good morning...

I could use some help with the following op note. We've coded it out to 11043 x1 & 11046 x45.

Pt has bilateral necrotizing faciititis on the bilateral neck spaces down to the muscle.

Op note reads as follows:
Given the concerns on physical exam and imaging, an apron incision was made extending from approximately the mastoid tip on the right along the anterior border of the sternocleidomastoid across the midline at the level of the cricoid to the contralateral sternocleidomastoid and then back up to the contralateral mastoid on initial and this incorporated her previous I & D drain, which was removed. On initial incision, there were copious amounts of discolored dishwater material. Tissue culture was sent from the platysma which was completely necrotic and nonviable, and the entire platysma muscle was debrided. The above findings were noted and extensive debridement was performed using Metzenbaum scissors, curet, scalpel and bovie debridement. This included the above muscles, the above square centimeters tissue. Necrotic tissue was debrided back to bleeding tissue and viable tissue and the wound was subsequently irrigated with copious amounts of antibiotic solution. The hemostasis was achieved with Bovie. A wound VAC was applied and she was subsequently transferred to the ICU.

Procedure performed: Incision and drainage and debridement of bilateral neck spaces:
A - extensive debridement of bilateral platysma muscle, 30 x 30 cm using sharp incision, a combination of curette, 15 blade and Metzenbaum scissors
B - Debridement of bilateral sternocleidomastoid muscles anterior surface right and left, each approximately 10 x 5 cm, sharp technique as above
C - Extensive debridement of the central compartment superficial strap muscles and partial eval of pretracheal neck space - approximately 5 x 8 cm, same technique as above


11043Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
11046Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

The major issue here is that there is a MUE of 10 for 11406 which would only account for a small portion of what he did. I have looked for any other codes that could be used that have "higher than 20 sq - or am I misreading it.

Any help is greatly appreciated
 

asmonger

Contributor
Messages
15
Location
Albany, NY
Best answers
0
The codes you selected seem correct. You can still bill the appropriate # of the add-on code 11046 regardless of the MUE and appeal with a separate letter or an addendum to the original report by the provider explaining the that the work was extensive providing any risks the patient had, total wound size, type of wound and length of the procedure to account for the coding i.e. patient with uncontrolled diabetes which hinders wound healing along with morbid obesity causing considerable risk under anesthesia for a total of 4 hours for debridement of an extremely large contaminated wound. The only other code set for debridement is the 11000 which accounts for % of body area but the RVU reimbursement is much less than the 1104X code set. If the provider plans to perform a graft of these areas at a later time (planned return to the OR) you can consider the preparation for graft code set 1500X.
 

barengland

Contributor
Messages
17
Location
Austin, Texas
Best answers
0
Thanks....I've asked the surgeon to go into more "detail" about what he did, to include things like comorbidities, time it took to debride that large of an area, etc....
 

EmilyCavuoti

Contributor
Messages
15
Location
Branford, CT
Best answers
0
I know this is a few months old but just in case... have you looked at 21627? Or that code range? Otherwise, I would agree with the codes you chose. We usually see those debridement codes used for ulcers, and there are tons of guidelines for that, and of course not for other, less common procedures but they can be used for other debridement. Without seeing the op note, 21627 is the only other code I can think of.
 
Top