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Excision of Burn Eschar. HELP!

  1. Default Excision of Burn Eschar. HELP!
    Medical Coding Books
    Post Op DX: 9x6 burn eschar left medial cast

    Full thickness and subcutaneous excision of eschar, final measurement 9cm x 6 cm x 1 cm deep.

    Anesthesia:
    TIVA

    After adequate sedation , left lower extremity was prepped with Chloraprep and draped in usual steril fashion. Excision was created circumferentially around the eschar and carried down to the fascia with excision of overlying necrotic and sclerotic fat. This was full-thickness, but did not go down to the bone though it did go down to the fascia. Hemostasis was secured with electrocautery and with surgicel. Dry 4x4s and Kerlix placed. Patient take to One Day Surgery suite in satisfactory condition.

    Path report states "DIAGNOSIS: Burn eschar and subcutaneous tissue left leg: Thermal injuries with intradermaland subcutaneous cellulitis with abscess formation."

    **I have never coded burns but my provider wants to bill 11043 and 11046x2. I am not in agreement. Everything I look at takes me to codes 16000-16036. 16020-16030 are partial thickness dressing and debridement and usually done in the doc office without anesthesia. This is more extensive. I am not sure about 15002-15005 because of the "surgical preparation or creation of recipient site" portion. 16035-16036 are throwing me off with "incision" and "otomy" vs. ectomy.Documentation does not state that. Any help you give will be helpful.**

    Thanks so much for any and all responses!

    Lisa

  2. Default
    I would go with 11043 (Debridement, muscle and/or fascia(includes epidermis and dermis, and subcautaneous tissue, if performed); first 20 sq cm. with add-on code 11046 (each additional 20 sq cm, or part thereof.

    The guideline in the surgery section in the CPT book under the heading "Debridement" will explain everthing.

    Hope this helps....
    Last edited by TonyaMichelle; 11-28-2011 at 02:34 PM.

  3. Default
    Thanks Tonya! I am still a little confused though. Under "Debridement" of CPT the statement "for burns see 16000-16035" is what is confusing me. I should mention our MAC is Palmetto GBA and there is an LCD. I can't use the burn dx and that is what was excised.

  4. #4
    Location
    Columbia, MO
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    12,531
    Default
    Quote Originally Posted by lalee03 View Post
    Thanks Tonya! I am still a little confused though. Under "Debridement" of CPT the statement "for burns see 16000-16035" is what is confusing me. I should mention our MAC is Palmetto GBA and there is an LCD. I can't use the burn dx and that is what was excised.
    I am not understanding why you think you cannot use a burn dx? There is nothing else to use in this scenario, the guidelines stated you code a non healed burn as acute.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Milwaukee WI
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    4,466
    Default Burn Dx
    Debra - I think the issues is that the burn Dx codes do NOT crossmatch to the 11043-46 codes the physician wants to use for the procedure.

    This documentation is really not very good (but you already knew that).

    I'm not seeing any closure of the surgically created wound (though perhaps you didn't include that part of the note), or I'd be tempted to use complex repair codes (which include scar revision).

    By the way, we frequently take patients to the OR for 16020-16030. These kinds of procedures are painful and depending on the age and condition of the patient, it is sometimes necessary to take them to the OR to perform this.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  6. #6
    Location
    Milwaukee WI
    Posts
    4,466
    Default Cellulitis
    Lisa,
    While this op note is sorely lacking, I do see a glimmer of hope for you in the path report, which shows "subcutaneous cellulitis." ICD-9 682.6 DOES cross-code to 11043.

    I would ask surgeon to modify his note to clarify, however, before coding it.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  7. Default
    Thanks so much for all of your help. Tessa, you are correct. The acute burn dxs are not
    on the LCD. I should have worded that better. I did not leave anything out of the note. It is just poor documentation. No mention of any closure. The doc states full-thickness but
    my 16020-16030 are partial thickness. My Coders Desk Reference does not mention full thickness down to the fascia or excision. When I look at the debridement codes I'm confused by "for burns see ........

    I am very appreciative of your help.

    Lisa

  8. #8
    Location
    Columbia, MO
    Posts
    12,531
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    Tessa i understand what you are saying but ifthe documentation states burn eschar then we would haveto follow guidelines that tells us nonhealed burn is coded to acute. The cellulitis and abcess are the consequence of non healed burn area, and the reason for debridement. I think it should be coded with the burn codes or sent back for better note.
    Also a fullthickness burn will needa graft at some point i feel the 15002 best fits this note at this time.
    Last edited by mitchellde; 11-29-2011 at 12:14 PM.

    Debra A. Mitchell, MSPH, CPC-H

  9. Default
    15002 it is!! i tracked my doc down and the patient is having grafting done elsewhere. Why it was not documented is beyond me but it is now! Thanks Debra and Tessa for all of your efforts. I was at a loss. This forum is great! happy Holidays!

    Lisa

  10. Default Healing second degree burn behind left leg
    need a icd9 cm diagnosis code for 4 cm area of eschar soft tissue swellconfused

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