Coding for Ulcer Debridement

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Transcription:

Coding for Ulcer Debridement

Faculty Jeffrey D. Lehrman, DPM, FASPS, MAPWCA Adjunct Clinical Professor Temple University School of Podiatric Medicine Panel Physician Crozer Center for Wound Healing and Hyperbaric Medicine Upland, Pennsylvania

Faculty Disclosures Dr. Lehrman: Board of Directors American Professional Wound Care Association, American Society of Podiatric Surgeons; Consultant Endo Pharmaceuticals, Molnlycke, Musculoskeletal Transplant Foundation, Smith & Nephew; Speakers Bureau BSN Medical, Smith & Nephew

Learning Objectives 1) Choose the proper CPT code based on the debridement that was performed 2) List the ulcer debridement CPT code options 3) Explain the diagnosis coding of ulcers related and not related to diabetes mellitus

11040 / 11041 Deleted from CPT Do not use them Ever Replaced by 97597 / 97598 January 1, 2011 Poggio A. Podiatry Today. A guide to coding for outpatient and in-hospital debridement. 2011;24(8). http://www.podiatrytoday.com/guide-coding-outpatient-and-hospital-debridement.

RVU = relative value unit. Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know. 97602 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion) including topical application(s), wound assessment, and instruction(s) for ongoing care, per session Non-sharp debridement For nurses/facility No RVU assignment for physician

Code based on deepest depth to which you debride Dermis Subcutaneous Muscle/Fascia Bone Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

97597 Debridement of open wound to level of epidermis/dermis total wound surface area 20 cm 2 Debridement defined as: High pressure waterjet with or without suction Sharp selective debridement with scissors, scalpel, and forceps Debridement should involve removal of: Fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

Examples Remember TOTAL Wound Surface Area One ulcer 4 cm x 4 cm debrided to dermis 97597 1 unit Two ulcers: first 2 cm x 2 cm, second 4 cm x 4 cm both debrided to dermis 97597 1 unit Three ulcers: 2 cm x 2 cm, 3 cm x 2 cm, 2 cm x 2 cm all three debrided to dermis 97597 1 unit

97598 Add-on code to 97597 To be used if wound over 20 cm 2 Debridement of open wound to level of epidermis/dermis each additional 20 cm 2 Used WITH 97957 No 51 modifier on 97598 with 97597 Never to be used alone Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

Examples One ulcer 5 x 5 cm 2 97597 1 unit 97598 1 unit Two ulcers: first 4 x 4 cm 2, second 4 x 3 cm 2 97597 1 unit 97598 1 unit

Examples (cont) Two ulcers: First 5 x 5, second 5 x 4 97597 1 unit 97598 2 units One ulcer 75 cm 2 97597 1 unit 97598 3 units

97597 / 97598 Fall under Medicare consolidated billing Will not get paid if patient is in a facility on a Medicare Part A stay Can try to contract with facility.good luck! Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

11042 / 11045 11042: Debridement to subcutaneous tissue first 20 cm 2 or less total 11045: Add-on code: Debridement to subcutaneous each additional 20 cm 2 Includes epidermis and dermis with it Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

11043 / 11046 11043: Debridement to muscle/fascia first 20 cm 2 or less total 11046: Add-on code: Debridement to muscle/fascia each additional 20 cm 2 Includes epidermis and dermis and subcutaneous with it Big jump in reimbursement from 11042 Submit pathology! Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

11044 / 11047 11044: Debridement to bone first 20 cm 2 or less total 11047: Add-on code: Debridement to bone each additional 20 cm 2 Includes epidermis and dermis and subcutaneous and muscle/fascia with it Submit pathology! Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

All Options Together 97597 up to 20 cm 2 97598 each additional 20 cm 2 11042 up to 20 cm 2 11045 each additional 20 cm 2 Epidermis/Dermis Subcutaneous 11043 up to 20 cm 2 Muscle/Fascia 11046 each additional 20 cm 2 11044 up to 20 cm 2 Bone 11047 each additional 20 cm 2 Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

Choose Correct Code Code based on depth of tissue actually debrided, not the depth of the wound Squared centimeters used is amount of tissue debrided, not the size of the ulcer Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

Examples Ulcer is 6 cm x 5 cm to depth of dermis, and you debride 4 cm x 4 cm of tissue to dermis 97597 Ulcer is 6 cm x 6 cm to depth of bone, and you debride 4 cm x 3 cm of it to subcutaneous 11042

Two Ulcers If, at same depth, one code for total squared centimeters debrided at that depth If debrided at different depths, then can use two codes Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

Example One ulcer debride 2 cm x 2 cm to dermis and another debride 6 cm x 6 cm to muscle 97597 59 mod 11043 11046

Included in Debridement Dressing change Local care training Topicals applied Aung B. Podiatry Today. Coding and wound care: what you should know. 2015;28(10). http://www.podiatrytoday.com/coding-and-wound-care-what-you-should-know.

Novitas 2017 Part B Physician Fee Schedule Non-Facility Novitas Solutions. 2017 Part B Physician Fee Schedule. https://www.novitas- solutions.com/webcenter/portal/medicarejh/pagebyid;jsessionid=st3l36vpeszar5ehq9e5uww- IA20juCkekRShzuiPDxPvub8Lxi_!- 852566205!39678795?contentId=00004345&_afrLoop=243449702456570#!%40%40%3F_afrLoop%3D243449702456570%26con tentid%3d00004345%26_adf.ctrl-state%3dgudvzuhuh_4. Last updated February 1, 2014. Accessed June 26, 20127. 97597: $81.73 11042: $126.93 11043: $249.05 11044: $343.86 All have zero day global

Check Your LCD 11043 / 11044: Need to send pathology? 11043 / 11044: Place of service? LCD = local coverage determination.

Documentation Different plans and different LCDs may have different requirements You are responsible to know We are talking about outpatient documentation requirements

Some LCDs Require Documentation supporting medical necessity for debridement (ie, why you are doing it) Decrease risk of infection Promote healing Salvage limb Medical diagnosis Anesthesia, if used

Some LCDs Require (cont) Wound size(s) in square centimeters Depth of wound Square centimeters of tissue debrided Depth of tissue debrided Drainage Color Absence/presence of necrotic tissue

Some LCDs Require (cont) Vascularity Operation report Patient-specific goals Wound better or worse?

Some LCDs Require (cont) Texture Temperature Condition of surrounding Tissue Presence or absence of infection Location of ulcer Presence or absence of undermining/tunneling

Some LCDs Require (cont) Instrument used Dressings used Immediate post-debridement care Instructions Methods of offloading Complicating factors/comorbidities

Photograph?

Diagnosis Coding Subtitle

Ulcer Options L97 - Non-pressure chronic ulcer of lower limb, not elsewhere classified Diabetic foot ulcers go here! L89 - Pressure ulcer APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

Stasis Ulcer Options I83.0 - Varicose veins of lower extremities with ulcer I83.2 - Varicose veins of lower extremities with both ulcer and inflammation APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

Arterial Ulcer Options I70.23 - Atherosclerosis of native arteries of right leg with ulceration I70.24 - Atherosclerosis of native arteries of left leg with ulceration I70.26 - Atherosclerosis of native arteries of extremities with gangrene APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

Wound vs Ulcer S91.0 - Open wound of ankle S91.1 - Open wound of toe without damage to nail S91.2 - Open wound of toe with damage to nail S91.3 - Open wound of foot APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

Ulcer Options L97 - Non-pressure chronic ulcer of lower limb, not elsewhere classified Diabetic foot ulcers go here! L89 - Pressure ulcer APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

What Type of Ulcer Is It? Pressure ulcer = Ulcer from pressure Diabetic foot ulcer = Ulcer on foot of patient with diabetes mellitus Arterial ulcer = Ulcer from lack of blood Stone A, Sieggreen M. Diabetic ulcers v pressure ulcers: so what do you call it? National Pressure Ulcer Advisory Panel.

Diabetic Foot Ulcer Coding Patient with type 2 diabetes mellitus with a chronic diabetic left lateral midfoot ulcer with necrosis of muscle Patient takes insulin daily

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

L97.423 Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org. E11.621 Type 2 diabetes mellitus with foot ulcer

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org. Diabetic Foot Ulcer Coding Patient with type 2 diabetes mellitus with a chronic diabetic left lateral midfoot ulcer with necrosis of muscle Patient takes insulin daily E11.621 - Type 2 diabetes mellitus with left foot ulcer Z79.4 - Long term (current) use of insulin L97.423 - Non-pressure chronic ulcer of left heel and midfoot with necrosis of muscle

Diabetic Foot Ulcer Documentation ICD 9 Chronic midfoot ulcer in type 2 diabetic ICD 10 Chronic, non-pressure left midfoot ulcer with necrosis of muscle in a type 2 diabetic with long term insulin use APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

PAD = peripheral artery disease. APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org. PAD I70.231 - Atherosclerosis of native arteries of right leg with ulceration of thigh I70.232 - Atherosclerosis of native arteries of right leg with ulceration of calf I70.233 - Atherosclerosis of native arteries of right leg with ulceration of ankle I70.234 - Atherosclerosis of native arteries of right leg with ulceration of heel and midfoot I70.235 - Atherosclerosis of native arteries of right leg with ulceration of other part of foot Use additional code to identify severity of ulcer (L97.-)

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org. PAD (cont) I70.241 - Atherosclerosis of native arteries of left leg with ulceration of thigh I70.242 - Atherosclerosis of native arteries of left leg with ulceration of calf I70.243 - Atherosclerosis of native arteries of left leg with ulceration of ankle I70.244 - Atherosclerosis of native arteries of left leg with ulceration of heel and midfoot I70.245 - Atherosclerosis of native arteries of left leg with ulceration of other part of foot Use additional code to identify severity of ulcer (L97.-)

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org. Gangrene I70.261 - Atherosclerosis of native arteries of extremities with gangrene, right leg I70.262 - Atherosclerosis of native arteries of extremities with gangrene, left leg I70.263 - Atherosclerosis of native arteries of extremities with gangrene, bilateral legs Use additional code to identify severity of any ulcer (L97.-, L98.49-) if applicable

89-year-old non-diabetic patient who lives in a skilled nursing facility with an unstageable right heel pressure ulcer

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

L89.610 L89.610 - Pressure ulcer of right heel, unstageable APMA [Web site]. Coding Resource Center. ICD-10-CM Resources. APMACodingRC.org.

Thank You!!

Additional Resources Fife CE, MD, FAAFP, CWS. The debridement dilemma returns. http://www.todayswoundclinic.com/debridementdilemma-returns?page=4. National Government Services. National Government Services LCD for Debridement Services (L27373). http://apps.ngsmedicare.com/lcd/lcd_l27373.htm. Just Coding News (August 8, 2012). Differentiate between types of wound debridement. Just Coding News: Outpatient. Novitas Local Coverage Determination (LCD): Wound Care (L35139). https://www.cms.gov/medicarecoverage-database/details/lcddetails.aspx?lcdid=35139&ver=40&cntrctrselected=324*1&c ntrctr=324&s=45&doctype=active&bc=aggaaaiaiaaaaa%3 d%3d&.

Additional Resources (cont) Kesselman P, DPM. Wound care billing update. Podiatry Management. September 2013:53-59. LeGrand M, RN, MA CCS-P, CPC. Changes in reporting wound débridement. http://www.aaos.org/news/aaosnow/jun11/managing2.asp CGS Medicare (May 9, 2012). Documenting surgical debridement services Measurements matter. https://www.cgsmedicare.com/ohb/pubs/news/2012/0512/ cope18819.html. Noridian Medicare. Wound care and debridement Provided by physician, NPP or as incident-to services. https://www.noridianmedicare.com/cgibin/coranto/viewnews.cgi?id=effzfzyyepajgdjcxk&t mpl=part_a_viewnews&style=part_ab_viewnews.

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