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Non-Pressure Ulcer Severity Coding

  1. #1
    Default Non-Pressure Ulcer Severity Coding
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    I do wound care coding for the professional side. I'm wondering how to code a non-pressure ulcer severity, when the provider documents tendon exposure, but doesn't state that the muscle is exposed with/without necrosis. Also, often times they'll debride the tendon but not the muscle. Would I code the 11042 or 11043 if debrided excisionally?

    Melissa Stogsdill, CPC,CGSC

  2. Default
    I am certainly no Wound Care Specialist, but there are new and expanded severity codes for Non-pressure Chronic Ulcers for 2018, in particular in the 6th Characters. The new 6th Character 5 is for "with muscle involvement but without evidence of muscle necrosis." This does not address either Fascia or Tendon, both of which are essentially a part of the muscle. The 6th Character 3 is for "with necrosis of muscle," which also doesn't address Fascia or Tendon. Lastly, there is 6th Character 8 which is for "with other specified severity." Since neither 3 or 5 includes Fascia and/or Tendon, then 8 may be the best option for this dilemma.
    As for the CPT codes you bring up, I would consider any debridement of necrotic tendon to be the equivalent of debridement of either or both muscle and fascia, i.e. 11043.
    I would like to see what others (the experts) say about this.

    Respectfully submitted, Alan Pechacek, M.D.

  3. #3
    Thank you for that information. It confirms my thoughts as well. But, I'm not an expert.
    Melissa Stogsdill, CPC,CGSC

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