Q: Where can I go to find out if the word “excisional” must be written by the doctor to code an excisional debridement?
A: Many professional coders will say that the physician must include the word excisional in order to assign a code for excisional debridement. I always taught students to use this word as well. So let’s start our investigation with the Alphabetic Index, as these guidelines need to be applied first when assigning a code.
At code 86.22 (excisional debridement of a wound, infection, or burn) the manual states “for removal by excision of: devitalized tissue, necrosis, and slough.” No other terms or synonyms are used to describe how the tissue was removed, except for excision. So physicians need to use that word specifically.
Now if you are debating this with a surgeon, he or she will have little desire to understand the inner workings of the code book. However, a number of issues of theAmerican Hospital Association's (AHA) Coding Clinic offer guidance.
Specifically, AHA Coding Clinic for ICD-9-CM, First Quarter 2013, states that the requirements in the index were intended to “encourage improved documentation…as to the type of debridement performed.”
It includes an example of a patient with a traumatic open wound, stating that clinically an excisional debridement may not be performed and that in many cases a nonexcisional debridement may be needed to clear the problematic area.
Editor’s note: Laurie Prescott, MSN, RN, CCDS, a CDI education specialist for HCPro, a division of BLR, in Danvers, Massachusetts, answered this question.
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
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