debridement and layered closure billing

mary-dressler@ouhsc.edumary-dressler@ouhsc.edu
in Part B Archive
Overheard a coding discussion recently at a conference and I wanted to get opinions from others. Patient was receiving wound care on the thigh. The physician was doing debridement with wound vac covering. As the healing developed, the physician closed the layers of muscle/fascia as it became viable. The final closure had not happened yet so the coders were discussing how to bill for this. One coder stated to just bill it as debridement with the wound vac placement. Another coder wanted to use a sub-q closure code with debridement, but felt that could bundle. Apparently the physician felt the closures were the most important part, not the debridement but the coders disagreed. Anyone have opinions on how to bill for this scenario?

Mary Dressler, CPC, CEMC
T: 405-271-1500 ext. 54180 F: 405-271-2499 Email: mary-dressler@ouhsc.edu

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Comments

  • eutsler@CHMBinc.comeutsler@CHMBinc.com
    edited June 2017
    I would agree with the physician here, the debridement would be a component of the closure.

  • mary-dressler@ouhsc.edumary-dressler@ouhsc.edu
    edited June 2017
    Thanks, but here is a follow up - How would that be billed because the 'official delayed closure' has yet to occur?
    Mary Dressler, CPC, CEMC

  • eutsler@CHMBinc.comeutsler@CHMBinc.com
    edited June 2017
    Hm. I think probably use 13160-58 for the deep closure; then use the appropriate intermediate closure (with 58) for the subsequent closure. If the deep closure was done incrementally, then maybe use complex wound codes 13120-13122 instead.

    It's really hard to tell without reports.

    ws.com
  • rubywdwrd@gmail.comrubywdwrd@gmail.com
    edited June 2017
    Good scenario. Debridement is included in the closure and extensive debridement allows you to bump it up to complex but in this case not appropriate if no closure. Since the wound is technically still open and a vac is being used maybe the 150xx series would be the way to go. It is preparation and a vac is being used. Not sure you could use repair or secondary closure codes in stages.

    Ruby Woodward
    Sent from my iPhone

  • mary-dressler@ouhsc.edumary-dressler@ouhsc.edu
    edited June 2017
    Thank you for all the responses!
    Mary Dressler, CPC, CEMC

    From: Ruby Woodward [mailto:rubywdwrd@gmail.com]
    Sent: Friday, May 05, 2017 6:31 PM
    To: Multiple recipients of list PARTB-L
    Subject: Re: [partb-l] debridement and layered closure billing

    Good scenario. Debridement is included in the closure and extensive debridement allows you to bump it up to complex but in this case not appropriate if no closure. Since the wound is technically still open and a vac is being used maybe the 150xx series would be the way to go. It is preparation and a vac is being used. Not sure you could use repair or secondary closure codes in stages.

    Ruby Woodward
    Sent from my iPhone

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