The fundamentals of debridement encompass various techniques, including both excisional methods, surgical debridement, and non-excisional methods, such as autolytic debridement, enzymatic debridement, mechanical debridement, and even maggot therapy. However, discerning whether debridement qualifies as excisional can sometimes pose a challenge for coders.
Excisional debridement involves the surgical removal, or cutting away, of tissue, necrosis, or slough. Typically performed with a sharp instrument like a scalpel, this method entails the precise removal of devitalized tissue.
In coding, the documentation standard for excisional debridement has remained consistent, unaffected by the transition to ICD-10-PCS. The key lies in the provider's documentation, which must explicitly state "excisional debridement" or unmistakably describe the procedure as an "excision" of the targeted tissue. Mere use of a sharp instrument is insufficient, and documentation must go beyond knife dissection to qualify as excisional.
In ICD-10-PCS excisional debridement falls under the root operation “Excision” which is defined as: Cutting out or off, without replacement, a portion of a body part.
On the other hand, non-excisional debridement involves non-operative techniques such as brushing, irrigating, scrubbing, or washing away devitalized tissue, necrosis, slough, or foreign material. Most non-excisional debridement procedures are categorized under the root operation of "Extraction," which involves pulling or stripping out a portion of a body part using force. For instance, debridement by Versajet falls under non-excisional debridement.
In cases where both excisional and non-excisional debridement are conducted at the same site, only the excisional debridement code is assigned, as excision serves as the definitive treatment.
It falls upon the coder to carefully review the documentation provided and determine the corresponding root operation according to PCS definitions. Physicians are not expected to use terms aligned with PCS code descriptions, emphasizing the importance of accurate coding interpretation.
References:
AHA Coding Clinic, Third Quarter 2015; Pages 3-8
AHA Coding Clinic, First Quarter 2013 Pages: 15-17
ICD-10-PCS Official Guidelines for Coding and Reporting 2016
AHA Coding Clinic, Third Quarter 2016 Pages: 20-22
AHA Coding Clinic, First Quarter 2018 Pages: 14-15
AHA Coding Clinic, Third Quarter 2018 Pages: 17-18
AHA Coding Clinic, Second Quarter 2020 Page: 26
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