Release of hip scar contractures

coderguy1939

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Doctor provided history indicating that the patient developed hip scar contractures attached to the iliac crest due to placement of halo pins for stabilization of a prior pelvic fracture. The op report indicates that scar tissue was excised all the way to the bone with extensive underming to release adherence of overlying skin. Any suggestions for procedure codes would be appreciated. I'm leaning towards the debridement codes at the moment.
 

coderguy1939

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Area of scar contracture was marked out on the left hip extending from just anterior to the anterior iliac spine going posteriorly for a distance of 11cm. An elliptical skin excision was marked out encompassing the entire area. This was then excised all the way down to the bone. There was some excess scar also noted directly on the periosteum and this was excised and sent separatelty for histologic evaluation. Generous undermining was done to release the entire adherence of the overlying skin and to allow the fat to be brought over the bone.

Then a simlar procedure was dictated for the right hip.
 
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My best guess would be 27025 Fasciotomy, 27041-51 Biopsy. (Either this or unlisted. I don't think using the just the debridement code is as clearly describing this surgical procedure.) The fasciotomy code seems to apply well for the contractures and since it does not include the biopsy, they are all billable together.
Complicated closures (wound vac, or closure requiring local or distant flap coverage and/ skin graft) are not included either - so this is another option to add on if applicable.
I hope this helps to at least point to in the right direction. Please post what you have decided to bill, I am interested in the outcome. Thanks!
 

coderguy1939

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I had looked at 27025 as a possibility, but the description is so specific about dissecting out fascial planes to release pressure from swelling that I thought it best to try to find another procedure code. AHA Coding Clinic 2nd Quarter 2005 re Excisional Debridement of Subcutaneous Tissue and Fascia says "in the abscence of an index entry for debridement of fascia and subcutaneous or soft tissue, look up and code the procedure as an excision of lesion specific to site. Debridement is coded to the deepest level of debridement performed at each site. Do not code separately debridement that is inherent to another procedure". That's why I was considering debridement or, as you suggested, an unlisted code. Let me know what you think. Thanks.
 
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I understand.... Personally I would still use 27025 and 27041-51. Deep scar contracture causes swelling and pressure. Hope this was helpful.
 

coderguy1939

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I spoke with the doctor's office today and they used 13300 (which is an code that is no longer valid) and a DX code of 709.2. 13300 is cross-referenced to 13102, 13120 and 13153. I've decided I'm either going with an unlisted code or the debridemnt codes.
 

haadi

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Scar Revision

CPT Assistant, Fall 1993, Volume 03, Issue 3, pages 7-8
How are scar revisions coded? There may be several answers, depending upon what the physician does to the surgical defect created after removing the scar. To answer this question, scenarios will be presented along with the correct coding for each.

The "excision-benign lesions" codes (11400-11446) can be used to report the removal of a scar; these codes include simple closure of the wound created by the scar removal. Note that in the guidelines for use of these codes, cicatricial lesions are one of the examples given. Cicatricial means "pertaining to or resembling a scar". A hypertrophic scar is an example of a cicatricial lesion.

For example, Code 11401 would be reported if a 1 cm hypertrophic scar of the forearm was excised and the defect was closed with a simple repair.

11400Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.5 cm or less
11401lesion diameter 0.6 to 1.0 cm


Many times when revising a scar, a defect is created. Scar revision requiring more than simple closure is reported using a repair code, selected by the type of repair performed and the extent of the scarring.

For example, a 3 cm scar (in length) on the cheek is excised. The defect created by the scar excision is now 6 cm and cannot be closed primarily without extensive undermining of tissue in all directions; the repair performed requires more than layered closure and results in a 6 cm linear closure. This repair is coded as 13132 only. No code for lesion excision is reported. Instruction # 1, page 102 of CPT 1993 states... "The repaired wound(s) should be measured and recorded in centimeters, whether curved or stellate." The wound being repaired in this example is 6 cm long and is therefore coded using 13132.

Hope this helps:)

Thanks!

Dr.Mohd Ali Hadi CPC, CPC-H
 
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