High-Risk Medical Coding: Debridement Coding & Documentation — AGSHealth

 

Driven by an aging population and an increase in chronic conditions like diabetic foot and pressure ulcers, along with a growing trend from acute to post-acute care, the U.S. wound care market is projected to grow from more than $6.5 billion in 2023 to $10 billion by 2030. Pressure injuries alone impact approximately 2.5 million people in the U.S. each year, claiming more than 60,000 lives and adding costs to the system of anywhere from $9.1 billion to $11.6 billion.

This rapid market growth has collided with heightened complexity and advances in treatment options and devices to make debridement coding a high-risk area that can significantly impact reimbursement if done incorrectly.

This rapid market growth has collided with heightened complexity and advances in treatment options and devices to make debridement coding a high-risk area that can significantly impact reimbursement if done incorrectly.

A Debridement Primer

Debridement is the removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. It is done using a wide range of devices, including maggots, lasers, ultrasound, monofilament pads, forceps, scissors, scalpels or other sharp instruments capable of selectively removing nonviable necrotic tissue from a wound. Types of debridement are equally varied and include: Autolytic , Biological, Enzymatic, Surgical, Mechanical

The type of debridement, instrument used, and depth of tissue are critical for determining the appropriate CPT codes.

Additionally, local infiltration, metacarpal/digital block or topical anesthesia are included in the reimbursement for debridement services and are not separately payable. Anesthesia administered by or incident to the provider performing the debridement procedure is not separately payable. Finally, the care of minor wounds such as dressing changes is incidental to other covered services.

Documentation and Medical Coding Challenges

The high level of detail required for debridement documentation — which must be descriptive enough to create a clear picture of the procedure performed — is tricky to achieve. Lack of detail and/or specificity makes it difficult for medical coders to accurately determine key elements like the type of debridement performed, device used, and/or the tissue depth. This is why documentation is the culprit behind most debridement claim denials or partial denials. Contact us for assistance with medical coding, including high-risk areas like debridement.

Originally Published at AGS Health’s blog: High-Risk Medical Coding: Debridement Coding & Documentation