Part of an occasional series of tips
for physicians prepared by SHC and LPCH’s Coding Section
Debridement Documentation

DID YOU KNOW THAT…

In 2005 Medicare paid $110 billion dollars through the DRG system, prompting the federal government to take a look at individual procedures. According to statistics from the AMA, more than 5 billion claims are submitted each year for payment of debridements. This number is continually growing at such a rapid pace that the federal Office of the Inspector General [OIG] has focused on debridements in its 2006 and 2007 Work Plan. (Then, starting in 2008, there will be a focus on wound care.) For further information, see OIG OEI 02-04-0041 work in progress.

Regulatory agencies believe that it is the provider’s responsibility to determine and submit appropriate codes, charges, modifiers and bills for services rendered. In an attempt to make certain that coding is demonstrated by documentation to prevent future payment loss, caregivers are being asked to help ensure appropriate and correct code selection.

The solution:
• Good documentation heads off allegations of unconcretized fraud and abuse. Document the debridement procedure by stating the method of debridement.

So...

• Does this debridement meet the criteria for Excisional debridement, defined as the “definite cutting away of tissue”? (AHA Coding Clinic for ICD-9-CM, 1991, third quarter, pages 18-19)

Excisional debridement

-Depth; did the surgeon debride beyond the dead or damaged tissue down to healthy viable tissue?

-Instruments used: were scissors or scalpel used? (The use of scissors is not good documentation for an excisional debridement because scissors may have been used just to cut away only loose fragments.)

-Scalpel or blade is better documentation than scissors because either indicates that an excisional debridement was done. However: A code for excisional debridement cannot be assigned based on the use of a scalpel alone.

• Document how much tissue was removed.

• Note wound dimensions and describe what you visualized before and after debridement.

… And keep in mind:

-Documentation must support the type and method of debridement.

-Debridement is performed by the use of sharp instruments, including but not limited to: scalpel, scissors, forceps or tweezers.

-Debridement includes removal of devitalized tissue and vitalized tissue.

For further info:
http://oig.hhs.gov/publications/docs/workplan/2006/WorkPlanFY2006.pdf
See page 9 for OAS W-00-06-35193

http://oig.hhs.gov/publications/docs/workplan/2007/Work%20Plan%202007.pdf
See page 10 for OAS W-00-06-35065