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0:03 Everyone, and welcome to Roundtable 146.
0:06 We’re definitely owner, thousand 22, Over 1500 registered for today’s event. Once again, what credits you all for taking the time out of your day.
0:16 To join us, My name is Scott Memtec, vice president of coding, education and continuous improvement.
0:22 First is H I M division.
0:24 And it’s my pleasure as always to introduce today’s speaker, Janice Tar Lackey.
0:29 Janice is Health Director of Advanced Education.
0:32 She’ll be helping us all decode debris and other complex procedures.
0:38 Janice request that you all have your decoder ring within the next five minutes. Some. Housekeeping, I didn’t warn you about that, Janice, and I know you didn’t hurt me.
0:53 There’s no column numbers. All right, the format is streaming only, and that is how many, the large number of attendees that we have.
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1:49 At present, we have quarter two up there, with quarter three to follow.
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1:59 Helps us understand that are hitting the mark, and if there’s anything that we can help your organization width.
2:06 That’s it, Janice.
2:07 Take it away.
2:08 Alright, thanks, Scott. Oh, my God, you got one laugh. Just thought, you know, when the questions come through. So, that was to. that was to last for one for me to. thank you. So, our today’s agenda. So, our main, our main topic it’s going to be decoding debridement. and then we’re gonna we have a report, for left frontal encephalitis, … school based Defect Repair. And then we’re going to end with a kind of a mini topic excision versus resection of the colon. And these are, these are things that I see or that we see on a somewhat regular basis. The frontal frontal … may not be as common but we do see a lot of school based repairs. You may, you know, depending on your organization, you may or may not see, though, so you’ll learn something if, not, at least, and then in terms of the debridement kind of circling back to that, we’re going to start there.
3:02 I do want to say that we do have another roundtable on this Roundtable 99 that’s gonna, that’s more in depth, depth presentation on debridement. So obviously, there’s not that many updates. We have a new couple of new coding clinics on Debridement, but in the sense of code and overall, if you’re a newer coder and you want a more in-depth presentation on Debridement, I would definitely start with That’s on our, Our webinar. If you just Google … webinars and it’ll take you to our landing page, and you can see all the recordings. And there is a more in-depth, in-depth presentation on Debridement, um, this is a higher level. So, if you’ve been coding for awhile, not, we’re not starting with the basics here.
3:42 We’re going to start kind of midway through learning are de Friedman’s because we continually see the same kind of errors when we see coding, coding Debridement, so some of this information we’ve I’ve presented before, but we’re going to kind of circle back and answer additional questions that have come through and whether I got them from a client, whether it’s from one of our coders. So, kind of their good scenarios to discuss and go through it.
4:07 So let’s start kind of with a high level overview of, of coding debridement with indication. So I’m not going to spend too much time here, But when we think about debridement, why do they, why does someone perform interbreed? Meant we think of pressure ulcers … ulcers. And please in the comments, if, if you have additional indications, please let me know in the comments, and I’ll, I’ll, I’ll call those out here. Of course, this is not an all inclusive list. So we have other ulcer type, so infected diabetic, ischemic Venus. I do want to remind everyone, we still see this as an issue with our QA.
4:45 That we can assume a foot ulcers diabetic, relate it with no other causes, state it, because of the width guideline, right. And, again, I’m not gonna get off topic here, but we, you know, we do, we have a lot of discussions about the width guideline. We still see coders using that guideline incorrectly, or not applying that guideline. There is a coding clinic on that.
5:06 Um, that’s been, since about 2016, we’ve had a lot of clarification since then, so I’m hoping that everyone knows it’s getting a little bit clearer about applying the width guideline. Of course, we have our non healing, surgical traumatic burns type wounds, that we can see debridement on also infection. So Cellulitis Abscess, Osco Fasciitis Gangrene soft are soft tissue infections, are bone infections, are skin infections. Also, I still, occasionally, we’ll see errors on Austria. We have an old Coding clinic that we, there was no ostia and the index under the width for diabetic diabetes. With. Back in 2017, they added the terms … yo, so we can now link it if there’s no other cause stated. Obviously, if they say the Ostia is related to, you know, … ulcer, we’re not going to link the CO two diabetes. But in the absence of any other documentation, we’re going to assume the relationship with you, and that’s because of the width guideline.
6:05 And there is a coding club Update at Coding Clinic on that. Also, this is another thing that I see missed quite a bit. We can assume cellulitis is related to diabetes.
6:15 We do have a coding clinic on that, because it’s not elsewhere classified condition, if we go to diabetes with, obviously, if they link it to the diabetes, then we can assume that are not assume the relationship, we have that cause Or relationship, state it, and so we can go ahead encode that, but this is also another if you’re thinking about coding upper query opportunities. This is a common query opportunity, whether the coders miss it, CDI misses it, et cetera. This is a common one that we have some opportunities to determine, you know, if there’s no other. If they don’t have a trauma, they don’t have any under lying condition that may be the cause of the Cellulitis, and they also have diabetes.
6:58 It might be something that we can, we can query to determine, is it related? Is it not related, et cetera?
7:06 Obviously, if they state another cause, like a traumatic wound, we’re not going to assume the relationship there, or you are never gonna assume it with cellulitis, but where we can potentially queries. what I’m getting at here.
7:19 OK, so let’s move into our, what does Debridement, we want to think about.
7:24 When we think about ICD 10 coding, we want to think about the intent of the procedure. So, when we code to …, we’re going to be coding that to excision, right? So, we want to see the definitive removal, cutting away of dead tissue.
7:40 In term generally speaking, Debridement is the Removal of Foreign Material Contaminated or devitalized tissue necrosis, necrosis, Sloths using either non … brushing irrigating. I think most of us at this point, no, That right washing, you know, versus jet ultrasound, or … cutting away of dead tissue, from a traumatic or infected legion until surrounding healthy tissue is exposed. So a lot of times, I think, one of the biggest issues that I see is, is it … versus …? And the documentation isn’t always clear, right? So I don’t know why why coders are afraid to query. But if we don’t have that documentation, we should be querying.
8:21 I mean, I think that’s one of the biggest issues I see with, with debridement, is, we don’t have the supporting documentation, and we need to query for that specific documentation.
8:33 So, first, we have our …, we want to see definitive, cutting away of dead tissue, mechanical or non … loosing, loosening, and removing wound debris using pressurized irrigation also, ultrasound. Pulse … are examples. We also have Auto lytic debridement not considered non non … Now, initially, when I first discussed this, there is a interestingly under written in the rehab section of our PCCS book, there is a wound mechanical. There is a and enzymatic debridement code, or application, of enzymatic Treatment, to a wound in the rehab section.
9:14 It’s us, and we have special dressing that enhances the body, natural process of using enzymes.
9:19 And then we have our Auto lytic, also called Enzymatic or Automatic, and that’s also Application of Chemical Enzymes to break down dead tissue. now, and I’m going to apply this to they.
9:33 They came out with some information for our romulan enriched, which is from pineapple enrich … enzyme for a new therapeutic substance. In 20 22 This is specific to this type of technology. It’s a new technology code, it’s used to remove … in adults.
9:52 And the reason I’m talking about this is because it gives them advice about enzymatic debridement and what we should use for that. We also have an option for … therapy. Another type of wound management, but we see here, in 20 22, they did create this code. Has anyone seen this yet? It’s called Nexo Bread.
10:11 Also, from Allah enriched proto lytic enzyme, and, again, they apply that to wounds to do partial thickness. and we have introduction to the introduction section, a prominent enriched, … enzyme into skin. They also have an option for … tissue. There is no new technology add on payment, I believe, off the top of my head for this. But they did create the new technology codes. So, on the, in the maintenance meeting notes, they do talk about how to code no, ends and enzymatic non … removal, using enzymes specific to this brahma. Lynn Enriched and they say, to use introduction of other therapeutic substance into skin and mucous membranes external approach, there was no specific code for that. So I’m gonna say it’s pretty safe, if you do want to code enzymatic debridement that, we could still use this introduction of, Other Therapeutic Substance, outside, of the, the Brahma Lynn enriched type, if it’s another type of enzymatic debridement.
11:08 My first thought was, you know, there is that option in the rehab section, but they didn’t advise using not.
11:15 Um, so, I’m just I’m just throwing this out here, that it’s not addressed in coding clinic or anywhere, other than in this, in the in the one document that I was able to find on the maintenance meeting minutes minutes. So, here’s some more information about the next Ope read, if you’re if that’s something that you see at your hospital, or if you’re just looking out for that.
11:38 It’s a it’s a botanical biological product. And it’s extract it from pineapple stems.
11:45 And it’s also biologic in nature with a gel vehicle.
11:51 And they talk about the administration that it’s soaked in this anti-bacterial solution to the wound for two hours than they mix the powder and gel, et cetera. So you can read more about that on the slide, But just to know that there is a specific code for this Brahmin romulan enriched proto lytic enzyme.
12:15 Um, hmm, hmm, hmm, hmm, So, in order to assign excision or non …, it has to meet the definition of … versus non excision. Alright? so let’s kind of go a little bit further into this.
12:28 When decode Degreed Mintz, typically, we’re not going to code … that are preparatory to further surgery. So, if it’s performed during reduction of an open fracture, obviously, this is …, this is … PCS for outpatient. We have different rules, right? So be careful if you’re applying or listening to us, and you’re an outpatient coder, Our advice in outpatient is a little bit different. And, of course, our minimal departments. In addition to the drainage procedure, we have a couple of coding clinics on that. You know, which is the definitive procedure, is the drainage procedure, the definitive procedure or is the debridement, the definitive definitive procedure. Just to throw this out here, I think that’s kind of a problem area for a lot of us. I think, sometimes, that can be a bit subjective. So, I have seen coders, or organizations, if we’re not 100% positive, if, which, is, the definitive procedure.
13:22 To actually query and ask the doctor, which one is, the, is the definitive procedure? The debridement, or the drainage procedure, What was the intent of the procedure, if it’s not clearly documented, I don’t know, let me know, in the comments what your organization is doing.
13:38 When it comes to that, I know we have we’ve had a lot of, a lot of discussion around that recently. Again, I think that’s a bit subjective, when applying that.
13:47 That guidance, non …
13:51 may be done at bedside in the documentation, is maybe found in the progress notes, So we want to also make sure that we’re coding, um, are debris events that are done bedside. Sometimes extension or departments are done bedside, but they are usually done in the operating room with anesthesia. But, again, not always so. I do, one of the things I see a lot of coders missed is the debris bins that are done bedside. You may, They may be embedded in the progress note. Those are the ones that we tend to miss completely.
14:18 So still be on the lookout for those, if you see the patient has a wound, you see that you consult wound care, You see they can they do, you know, other people besides provide a per visit physician can do departments like our PT people or wound care nurses, et cetera.
14:37 Now this is an oldie, but we want to remember this. The term sharp and oxygen are not interchangeable are synonymous. We have a coating connect. The use of a sharp instrument does not always indicate that an extension on debridement was performed. And this is another area where I see coders missing the missing query query here. So, did, is it, or they excising tissue. Did they document that? They excised tissue or they document, they did an exigent debridement.
15:06 Did they have to specifically say, decisional debridement if they say excision of tissue or excision of necrosis excision, they sought specifically excised that tissue. We it meets the definition of excision, right? So we’re good to go. It goes to the same code, regardless. It goes dark decision of root operation.
15:26 So if they’re excising tissue, we’re going to be coding that to excision.
15:29 If they don’t, if they just say sharp, sharp debridement, that’s not enough to code that we’re going to need to query.
15:39 And here, you know, I think most of us at this point are aware that other people, this is back from 2014, 2004, that other providers, such as physical therapists, can document excision, debridement, et cetera, et cetera. Just in case, you know, someone had a question on that. I threw that in here, OK? So this is probably to me, the most important slide, right, our thought process for coding debridement.
16:06 What is the condition requiring debridement?
16:08 We always want to know the intent of a procedure and this is for any procedure is the intent to excise. The tissue is the intent to drain. The abscess is the intent to remove a device.
16:20 What is the intent of the procedure? We need to know that information.
16:24 Um, that’s probably the: that’s probably one of the most important questions that we should be asking ourselves, because sometimes, you know, the intent, well, you know, is it release, is it extirpation, is it decision, Is it what is the intent of the procedure, is going to help us determine what route operation we’re going to be using.
16:43 Regardless if this is we’re talking about Debridement, I think this is kind of the thought process that we we see being left out when we’re thinking about procedures, OK.
16:53 So what is the condition requiring Debridement, OK? We’ll say it’s an ulcer the intent of the procedures to remove Devitalized tissue necrosis, right? The intent the patient has a huge abscess.
17:08 They want to drain that fluid, OK? So when we think about two bereavement, we want to see those indications and the intent of the procedure clearly delineated in the documentation. So next the body system is its skin as its sub Q: Is it? Fascia? Isn’t muscles and versa ligament joint tendon bone? Is it safe? Is it, is it …? Is it breast? What type of tissue are we do breeding?
17:33 We want to think through what is the method used to remove the tissue? Is it … is it non … what type of instrument are they using? Are they using a …? are they using a lava or ash?
17:42 Are they using an ultrasonic …?
17:46 Those things are going to help us kind of determine what route operation we are going to be using. What is the extent and depth of the debridement. So, if it’s overlapping body layers and we’re going to talk about that, too, because overlapping body layers in multiple sites are different, right?
18:02 So, most overlapping musculoskeletal body layers are skins up to fashion muscle, et cetera, right down to bone, tendon, et cetera. We wanna think about the deepest layer debris of that body, that body, that body area, and multiple sites to breed it.
18:20 Maybe they have, you know, to friedmann of the ******* and debridement of the groin. those are different body areas, right?
18:30 And they’re making different incisions or they also have one on the inner thigh. Maybe that the infection is extending into different body parts.
18:39 Not just different layers.
18:42 So we want to think through the site and location, and even … of Debridement.
18:48 So thinking through our critical thinking questions, what body system value should be used? Or … debridement should be used for our external dobrynin of skin and soft tissue fascia and muscle, which is the deepest layer.
19:09 OK, so … Department of Dermis are they going to always say Skin so the dermis and epidermis, our skin we don’t have an option for dermis and epidermis and our PCS table. But the dermis and epidermis make up the skin right? So we’re going to be coding that to skin.
19:24 Exceptional debridement of soft tissue now soft tissue is a generic term, right? Do we have to be more specific than soft tissue?
19:32 We do write. What kind of soft tissue Is it? Subcutaneous tissue. Is it fat? Is it fascia?
19:38 Is it muscle? What type of soft tissue is it?
19:42 Do we have an option for soft tissue in our PCS table soft tissue not otherwise specified?
19:50 An inverse a jet debridement of naucratis fat, sometimes I do. So we have to remember versa. Jet is considered non … debridement, we have. We have advice on that, sometimes I see providers documenting, or clinicians documenting … using ….
20:05 In their mind, maybe it’s exceptional debridement, but diverse, defined and PCS terms is not ….
20:13 So we want to think through that process as well, and kind of use our critical thinking to make decisions.
20:22 A lot of times, I don’t see coders if they don’t say the specific they just, say, exceptional debris men of Botox or this accidental debridement of leg.
20:31 A lot of coders may just code that to skin, but what is the level of debris that we need to know that level of debris meant?
20:36 A lot of times, they don’t document the level debridement so we need to query for that. That’s another one that I seek missed quite a bit, and that layer is the layer that whether it’s …, whether the depth of removal, all those things will impact our DRG assignment, right?
20:55 Or not impact our georgi assignment depending on what we have coded pertinent coding guidelines.
21:02 So going back to our skin and subcutaneous tissue, we have our skin and subcutaneous tissue. We have fascia in our table. We have sub beauteous tissue and fascia.
21:15 So the subcutaneous tissue would be deeper than skin, right?
21:18 So, just a reminder, when we have the word and, in the code description, it means, and, and, and, and, slash or. So, if it’s … tissue and fascia.
21:31 Even though it says And in the code description, it means and And Or So, we’re going to take the deepest layer as … tissue, even though it says fascia in that body system.
21:42 Just a reminder about that.
21:45 And then we have our multiple procedure. So we kind of alluded to this a little bit.
21:49 If we have multiple procedure, the same root operation is performed on different body parts, as defined by distinct values of the body part character. So if we have …
21:58 being debris to it, and the ******* being debris that those are distinct values or body parts, So we want to remember that we can code two different body parts for that.
22:13 And then also we want to remember if we have multiple operands operations with distinct objectives. We can also code code, though. Sometimes that happens with if they’re doing a graft, they do a debriefing of attendant, and then they do a skin graft, right? We have those multiple root operations with distinct objectives. It’s not just preparatory, they’re going deeper with the debridement than they’re placing the graft. So we do have a Coding Clinic example on that.
22:40 Next, we have our guideline overlapping body layers. So we see that with excision and extraction overlapping layers of the musculoskeletal system. So if they’re debating the leg and it’s of the skin and subcutaneous tissue and muscle, we’re gonna code that to the muscle body part, right? Because that’s the deepest layer.
23:00 Then we have our excision resection followed by replacement. So, if an excision or resection of a body parts followed by replacement procedure code both procedures to identify each distinctive objective except when the excision or resection is considered integral and preparatory for the replacement procedure. So examples, mastectomy followed by reconstruction. I’m gonna kind of skip through these a little bit and get to my point here … of tendon with a skin graft. Both the excision of the tendon and the replacement of the skin with a graph terracotta to fully capture the distinct objective of the procedures performed.
23:34 OK so this in that case it’s not just preparatory there going deeper than the replacing the skin graft.
23:46 Other helpful guidelines, when it comes to coding Debridement Perry, the Prefix Perry.
23:52 So, if they’re saying peri, renal, we’re going to code it to the kidney body part.
23:58 Other examples procedure described, as Perry Urethra, and the documentation also indicates that it was the volver tissue.
24:05 It’s not the urethra tissue that it’s more specific body site there is the *****.
24:10 And then, the one of the biggest ones that I see with debridement is the procedure document and document as involving the Perry Ostium is coded to the corresponding bone body parts. So, that’s a layer of the bone.
24:24 I don’t see too many errors or questions on that anymore.
24:28 But we do have a Coding Clinic also, that came out before this guideline, and now, we’re now, it’s, it became part of our guidelines.
24:35 Don’t forget if it’s bilateral body parts, that we are picking those up.
24:39 We have a couple of example, examples for Box, for when that’s one of the ones I can think of.
24:44 Tendons, ligaments Bursa unfashioned near a joint so any of those tendons, ligaments, bursa, and Fascist supporting a joint, or according to the body part and the respective body system. So sometimes I see coders, coding this.
24:57 You know maybe a ligament to a joint instead of the ligament or tendon, etcetera. Just reminder that we want to code it to the correct.
25:08 Correct body system. Is it actually within the joint itself, or is it a supporting structure to the joint?
25:17 So an ACL will just say, this is an ACL debris, man. We’re going to code this to the knee burson ligament if it’s a neat arthroscopic. What shaving of the cartilage within the knee joint? It’s gonna go to the lower joint body system.
25:31 And then also, sometimes I see this, encoder kind of helps with some of these things. But just a reminder about skin, …, tissue, and fascia overlying a joint. If it’s, if it’s the shoulder, it’s going to code to upper arm. If it’s the elbow, it’s gonna go to lower arm wrist, lower arm hip, upper leg. Knee is lower leg and ankle is echoed it to the foot. So, these are all in our guidelines, and I think we, we tend to forget about the information in our guidelines. That’s why I’m discussing this. I always recommend having your guidelines out and referring to them. We obviously can’t remember every single guideline off the top of our head, but sometimes I’m thinking, OK, I remember something about, you know, the ligaments. let me go and search ligament in my in my copy of the guidelines.
26:15 Fingers and toes approach. We also have percutaneous procedure via device. The approach is the next one that I see a lot of questions about. So external is procedures performed within an ******* on structures that are visible without the aid of any instrumentation. Our Code it to the approach externals. So example resection of tonsils as code it to the approach external. And for certain procedures performed indirectly by the application of force through the intervening body layers or courage the approach external, Example, close reduction of fracture is coded to the approach external. And then procedures performed percutaneous lee via a device for the procedure code it to the approach, percutaneous. So, Fragmentation of the Kidney Stone, performed via percutaneous … approach, percutaneous. I don’t know for some reason.
27:04 Well, I have a couple of examples with external and percutaneous. So if it, if you can visualize, you know, the skin and it’s directly on the skin, the procedures performed directly on the skin, that’s usually going to be external. And then our via device, I don’t I’m not sure some coders want to code.
27:23 And then they make an incision into the abscess with a scalpel and they drain the abscess want to code that’s a percutaneous. It’s not the same as a needle. But they’re just placing the needle in in training the abscess.
27:34 They’re actually making incision into three layers into the muscle, perhaps, Et cetera, et cetera. So we want to be careful with our approaches as well. We’ll go through a few different examples and another reminder about devices. So sutures ligatures radiological markers, post-operative wound drains this is the biggest one is the temporary postdoctoral drains. If they’re just putting in a temporary post upland dream, we wanna make sure that we’re not coding that Those are integral to the procedure and are not coded as devices.
28:06 I see that when we have debris mintz versus drainage procedures, is it truly a catheter, they’re placing Or is it a temporary post-op wound drain to help that wound drain?
28:17 And they’re going to remove it once that drainage kind of comes down.
28:23 OK, so we kind of talked about this so I’m gonna go through this quickly. Our dermis is which body system epidermis, is epidermis and dermis make up the skin layer. So we’re going to be coding that to skin. Sometimes they will say dermis or epidermis. We have to know that skin in terms of our anatomy.
28:40 Tough cutaneous tissue.
28:43 it can be the sub queue tissue.
28:47 It could be the fat, the connective tissues, etcetera.
28:51 So, you have to pay attention to, to that specific detail. Tendons, ligaments, and bursa. We have our fascia layer and then we have our muscle layer.
29:04 Then we have our four layers of bones. They might say Perry Ostium, they removed, that they went down to the Perry Ostomy, Perry Ostium and …, they may talk about going into kernel cortical, bone, cow keenest bone. I don’t typically see them going that deeper bone marrow, depending on what specifically they’re doing. Usually you just see them talking about the Perry Ostium unless they’re doing some type of excision of a bone of, like, definitive excision or the head of a bone not just a debridement.
29:39 OK, so, most common approach values we want to keep in mind when we’re using excision and extraction route operations. There may or may not be options, for approaches, or body, Sometimes, we have to go with the most.
29:52 The one that, kind of go is the most What’s the term they use, I’m drawing a blank on that word, closest equivalent. And we have that and this is one of the problems I have with debridement of joints, non excision onto prevents of joints. We don’t have an extraction table.
30:11 four joints, correct me, if I’m wrong, and the Coding clinic says, it was a drainage procedure, and at minimal debridement, they tell us just to code the drainage procedure, But what if it’s a A, a major, non … of the joint.
30:27 And I’ve seen that that come up and documentation, So I think that’s still one of the problem areas for … are non-existent. departments of joints. They still haven’t addressed that fully.
30:37 In my opinion, OK, so, with our skin or skin of the breast and not deeper than the skin of the breast, most common is going to be external, right? Procedures performed directly on the skin.
30:49 Breast We’re going to cut through the skin or mucous, membrane and other body layers to reach the breast tissue that’s going to be open, sub, Q and fascia, muscle, bursa, ligaments, tendons joints, bone, and brain. Typically, that’s going to be open, right? Cutting through the skin or mucous membranes and other body layers necessary to expose the site of the procedure joints, we also have the option of percutaneous endoscopic. When they do our authors, arthroscopy is entry by puncture or minor incision, and they insert, insert the instrumentation through the Skin or mucous membrane and any other body layers necessary to reach the site at the procedure.
31:23 Again, these are the most common, are there other other options, of course, but these are typically typically the most common that we will see.
31:32 So you want to keep in mind your definition of approaches when you’re assigning your, your, your, you’re the friedmans.
31:43 Kind of just sum up our excisions Debridement, so its definitive or definition is cutting out or off without replacement a portion of a body part. So the documentation standard did not change from ICD nine to ICD 10. For any of us that are used to all the rules that were in place for ICD 9 and 10, this should not be anything new to us. Documentation of debriefing should be very specific regarding the type of debris. And if it’s not there, we need to query right. Documentation should, say …, or some other similar term Excised necrosis, … Debridement description of sharp instrument again is not enough to code the Root Operation Excision.
32:24 Review the Procedure Note for the presence of an oxygen onto Brilliant definitive, cutting away of tissue, not the minor removal of loose fragments. A code for exceptional debridement can be assigned based on the documentation of … or the documentation meets the operation definition of excision. Now, some may argue with this, based on their denials, based on advice that we’ve gotten from our co-operating parties, if the doctor is stating excision on to breed meant, we can code it as excision debridement.
32:50 Obviously, we want our documentation within the body of the report to match, and we have enough meat to assign the Exceptional Debridement code. If not, we can always query for additional information. Did they excite what type of tissue did they exercise? I know we have a lot of issues with that. But they do save the document … debridement That’s enough to assign … Debridement.
33:15 If the documentation is not clear, other than, there’s any question about the procedure, again, the perceived provider should be queried. Knife dissection is also another term that’s insufficient to code the root operation excision.
33:27 As it can mean, referring to the means used to reach the operative site, and not necessarily what was done at the site, Department of bone, fascia, tendon, or muscle should not be assumed to be … right? They can do a … maybe it’s an exposed to … ulcer and it has exposed muscle and they’re doing it versus jet debridement, which would not be considered excision. That would be one example: If a debris minutes performed to clean the open wound as part of an open reduction. It would not be coded separately.
33:56 Any excision debridement is coded separately when performed on a deeper level than a skin graft so if they’re doing a skin graft we talked about this. They did a … of the tendon and then they place a skin graft those are considered. Those can be can those it’s not considered just preparatory to the surgery.
34:10 You can go ahead and assign it and also the one of the biggest things is multiple layers at the same site. We want to only code the deepest layer.
34:20 And that goes for not just excision. That goes for repair extraction inspection. We want to code to the body of the specimen. the deepest layer. Coated.
34:29 These are all the coding clinics.
34:33 So example excision department that includes skin, subcutaneous tissue and muscle was coded to the muscle body part. The documentation down to including so that’s another thing.
34:43 Sometimes it says down tube, but they don’t see it included the bone or down to, um, and including the muscle.
34:50 We want to make sure that it’s including, if they just say down to, Does it include that layer they went down to, or, is it just they’re just going down to the fascia, to actually include the fascia?
35:03 And sometimes the documentation will say that, and sometimes it won’t, so we may need to query if it’s going to change anything.
35:10 If an excision on non traditional debridement are performed at the same site, only the excision debridement’s report it and we have a coding clinic on that.
35:18 … muscle debridement of the sacrum does not specify ladder out. We’re going to sign block codes for both the right and left hip excision, and that’s, again, a coding clinic. We’re not gonna go over every single coding clinic, We could be here for days, right? I do have a list in the next upcoming slides with a listing of most of the coding clinics. So if it’s something that you want to review in more depth, I do have a list of, of the ones that we talked about indirectly on, during this presentation. The Perry asked him is part of the bone, and therefore is coded as bone ICD 10, PCS does not separately classified … tissue as a body part value. Therefore we’re going to assign the code for the agreement of the underlying bones if you see that document it. We should also look for additional procedures performed with additional objectives or intent. So like we saw with the boat, the skin graft and the tendon, for example those are other is another example.
36:13 So, talking about non excision order agreements, so pulling or stripping off all of a portion of a body part. So they can use high pressure irrigation, mechanical irrigation, peeling off inspect infectious material in the Dura Postal … ultrasound device. They can use a scrubbing action, right.
36:30 Anything anything like that would meet the definition of extraction, non operative brushing, irrigating scrubbing washing of our necrosis slaughter foreign material, most, not most non …, are classified to the root operation extraction, So pulling, or stripping all of a portion of a body part. The same applies to our extraction procedures. When multiple layers the same site, or to breed it, we’re only going to assign the code for the deepest layer.
36:58 We want to code to the body part. Is that as a closer look, closest equivalent when coding excision onto … of deeper layer.
37:07 Bone, muscle, or tendon, non excision of departments may be done at the bedside and documentation found in the progress notes. We don’t wanna miss coating that. Again, we still see coders missing departments that are done bedside. And then documentation should be clarified. I don’t know why we, when we don’t see the depth of debris meant that we don’t, we don’t query. You can plug it in and see how it affects your DRG assignment. Is it, whether it’s … or non-existent or whether the depth, you need the depth, you can kind of plug in those codes and see how it’s impacting your your, your DRG.
37:50 OK, so coding questions. How would you code … a bio burden of the right lower extremity? So this is the documentation. What do you guys think is needed for us to code this correctly? Does bio burden make a difference here? Patient has been followed at the Wound Care Center for continued management of this wound. Last visit was started on PO.
38:09 Antibiotics for infection presents today with increased cellulitis and pain along the maturation and extensive edema of the right lower extremity. Patient was sent to the ED for further evaluation and admission, Requiring intravenous antibiotics will review for possible bedside debridement.
38:24 Patient debris that bedside, again, this AM with light OK, and Cream …, Department of Bio burden using a 15 blade scalpel wound size measurement post agreement 75 point. By point to patient tolerate the procedure at bedside without complication. Can we code what can we code here? Oxygen or debris bio burden?
38:44 What’s missing is anything missing, or how would we code this?
38:50 We have the fact that they’re saying Excision on debridement, but what else do we need to code this correctly?
38:58 OK, good, so we’re missing the depth.
39:00 What exactly did they, they they de breed here. There’s not enough information for us to assign a code. We need to query this.
39:09 Good, great. So we need a query for debridement, we can’t we, at the, at this point, we don’t have enough to assign a code.
39:15 Bio burden is just referring to the effect it material, but not the depth, right.
39:21 So great, everyone seems to be on the right, on the right path there.
39:24 But these are the kind of questions that we get, and these are the kind of questions that we see, or we that we see arndt queried four and the coder or maybe just assigned Extension or Department of Skin.
39:39 It probably may be skin, it’s cellulitis but we don’t know for sure where it could be sub involving the subcutaneous tissue. So we’re going to need to query to get that information.
39:52 OK, would you code the non exertional debris minute of the leg in tow as open?
39:56 OK, so we have Debridement subcutaneous tissue. Is it … a document, non … they say, hyper keratosis and Sloths, they say they use a caret four mm and Moisten, gauze, minimal bleeding and no pain, direct pressure for him of stasis. They wound one was the lower left leg. We have post agreement, measurements, wound, the second, toe, right, distill, post agreement measurements, and then dip read it.
40:22 1.33 square centimeters on post procedure, dressing patient tolerate it procedure well.
40:36 OK, so would you code it …
40:39 eyes open, we have, let’s take a look. So thinking through our thought process, we have the sites, right? We have the sub. We have the fact that it’s … tissue of the lower leg and the toe. So we have two different sites here. We have …
40:51 tissue, We have the fact that it’s non excision, all we have, that it’s documented as sloths What about the the the What would we code as the approach here?
41:12 OK, Good. So we would be coding this to open, right that First of all, there is no option for subacute. There’s no perfect. There’s only a percutaneous option for … tissue. There’s no external option. You can’t get to external tissue, or you can’t get to subcutaneous tissue. It’s not considered external. So the only option that we have percutaneous would be incorrect. They didn’t stick with some type of device in the patient and pull out the tissue. That was an open wound and so, that wound is already open, so, this is going to be coded to open, open is correct.
41:45 I did have a question about this. So, they actually, someone actually got this back as a denial where they said, Well, they didn’t do it. Make an incision, so it’s not open.
41:59 OK, so, the in this case, the wound is already exposed, right? So, we’re not making an incision.
42:06 However, the site is already exposed, it’s deeper than the skin.
42:11 So in this case, it would be the, it’s going to be open, right. This would be this would apply to the same for a laceration.
42:19 You were in a cold laceration repairs as open approach, you know, salutation is tissue open approach because the wound is already open. We do have a code, I didn’t put that on the screen, but they have, they addressed this in, for laceration repairs as open. and coding clinic. Fourth quarter 2013, page 120.
42:38 If you need to defend yourself on that.
42:41 Um.
42:45 So if there’s a knife wound there and the site of the procedures already exposed, it’s still considered open approach.
42:52 All right, great job guys.
42:54 All right. So next question with the buttocks woon tracking down to the …, do I consider this a single … into the deepest layer? I’m reading this as the … muscle with the agreement of the ***** them as well. I’m also seeing counter incisions with nothing done to them. So, what this? What would this just coated exploration as I have it? So they didn’t excision of the agreement of the …, the total sized area. So, we see excision, right?
43:20 The size, the area of the skin and subcutaneous tissue to the muscle, significant non viable muscle on the right ******* requiring debridement, minor, non viable tissue in the right box requiring debridement. Counter incision is made in the interior, right? … right? Groin and the right Inner thigh with Healthy appearing Tissue. So they didn’t actually do a debrief in those areas but they did make incisions into those different body parts.
43:45 So the patient had rapidly progressive infection of his … concerning for necrotizing soft tissue infection. He had symptoms for approximately one week, which rapidly progressed at the time immediately prior to his presentation. He was dynamic heman dynamically within normal limits, and take an urgently to the OR for debridement. So, kind of just highlighting the areas here. We started with exploration of the ******* and notice significant devitalized in non viable tissue around the right …, which was debris to it until appropriate bleeding, was encounter. The tissue surrounding the left ******* appeared healthier. The testicular sacks were noted to be intact and overall involved. So, they’re breeding the ******* that’s not a musculoskeletal body part. We’re going to be coding, scroll them to ***** them, right?
44:28 Yeah, that was, Yeah. So there is a coding clinic when the site is already open and expose the approaches open. Yep.
44:34 I was just giving one of them, OK. We then turned our attention to the right buttock so they’re making another separate incision in the buttocks area.
44:44 So if we think about our body parts there then turning our attention to a different body part, the right box, they not noted a moderate amount of devitalized tissue which is XI sharply with scissors and electro …. The size 5 15 centimeters by five centimeters including skin and subcutaneous tissue to the muscle.
45:01 The wound tracked entirely towards the groin. so we’re going into another body part. Right? An incision was made an interior right … along with the second incision over the right groin.
45:10 There was notably no significant devitalized tissue requiring divide organization at the sites of these counter incision, so they’re exploring this area. They’re not actually excising anything but they’re in a different body part. If you look up the different body parts in this area, they made a different counter incision. This incision didn’t communicate with the perinatal region as it was separated by the expected expected facial planes. There is also no devitalized tissue in the right, medial thigh, wound, requiring debridement with no further … tissue was all new. Noted all wounds were irrigated and dried. So we kind of have to use a combination of this documentation and back to the findings to make a decision about how we’re going to code this. So we’re going to be coding to different agreements, right? Go, so thank you. So we have a … of the ******* and then a debris admin of the buttocks, and then we asked they also explored the …, and the groin, and the thigh. So if there’s different body parts, we have to make sure that we’re capturing all those different body parts as well.
46:08 Um, so we have to pay attention. Is it down to and including the muscle?
46:14 They didn’t say it was including the muscle. They weren’t did they talk about the … planes, I would probably argue this, that didn’t include muscle, They talk about that. They went down to the … tissue.
46:27 I would also consider obviously the two different debridement, the right box and the ******* and also I do agree with coating the inspection procedures of those other body parts.
46:42 So they did make other incisions into other body parts but didn’t actually end up to breeding those, right? They didn’t drain anything. They just made incisions and inspected them So it’s going to be an open inspection of those areas. So we want to think so this would be an example of multiple procedures. We want to make sure that we’re capturing all the procedures that were done.
47:03 Next, another question. We have a question on this procedure done in this patient. He’s here’s the Opera Report. I coded as excision of scroll down the CDI coded as excision of subcutaneous tissue pelvic region and drainage of the *******. A query was done on the debridement type and depth and was answered the upper right scuttle tissue tissue. Excision. Debridement was performed with removal of affected skin and subcutaneous aquatic tissue.
47:25 With excision code, would this be, would this be appropriate? In this case, also, since debridement was done with the drainage need to be coded.
47:32 I know normally it is not, but CDI felt it needed to be coded separately. So you can see how this could be a bit subjective. I think the query answered that they talk about the right upper skrtel abscess. Let’s actually read the report with a small area of ischemic neurotic tissue.
47:47 They have accompanying right Scrotal cellulitis the right or … Midas.
47:53 And so, after discussing this with the patient, they decided to proceed with incision and drainage of the abscess and tissue to prevent of the upper right skrtel tissue. Let’s keep going Here. They sign consent.
48:07 A time that was performed. The lower abdominal area in the genitalia area was prepped and draped in a surgical sterile fashion. The upper right is fertile abscess site was drained with an insides with a 15 blade scalpel and a three mm incision, a small amount of current. A small amount of … drainage was expressed from the site. Small amount of … tissue was noted, tracking towards the right and, you know, can now and this was successfully to breathe it in tissue was sent to microbiology.
48:36 So what is everyone’s thoughts on this? My thought is that it’s the same site, the same area. To me there, the intent was to also remove … tissue.
48:45 In both cases they drained a small amount of of of liquid and they also removed a small mountain, a … tissue. So to me, the most definitive procedure here is the debridement of the … tissue, so in this case, I’m probably, I’m probably just going to be coding the decision of the ***** them.
49:09 I don’t know, everyone, let me know your thoughts on that one so far.
49:11 I don’t see any, OK, good.
49:13 So, one person is saying that it would only code the debridement the same site, it’s not a separate incision.
49:22 They do say it’s a small amount of tissue and this is where I was getting to, sometimes I think this could be upset, subjective.
49:30 I have one case where we were discussing this, and they want to, the client, want it, the drainage procedure code it. And because they said a small amount of tissue is removed, but in this case, and they say an ischemic area, they have a known ischemic … tissue and that was the intent of the procedure. So, to me, in this case, I’m going to be coding this as Debridement.
50:03 There are a couple of coding clinics, if they’re at the same site.
50:06 They talk about just coding them more definitive procedure, so I don’t see a lot of updates on that, an ICD 10, so I think maybe I will see you all. I see everyone’s point about that, So, maybe I can submit this one just to get clarification. But, going back, in time, there is one, with breast. I forget if there’s one with ICD 10, about if they didn’t do an incision and drainage, and to prevent the same site, you just coded debridement. So, I’ll probably have to submit this one just for clarity in my opinion outrageous code based on what I know of in the coding clinics, would be coding this just to Debridement.
50:47 Like, that’s what I, that’s my thoughts on this.
50:51 OK, we have, I have a question about the procedure code to use In this case. The patient has septic arthritis into … was done. A query was sent to the physician for the debridement type, and it was answered that it was excision on the capsule, was excised.
51:05 The CDI in the case, and I are having a hard time figuring out the body part to use. I use hip Joint Encoded OSB nine Zeros Easy. See, I use burson ligament Encoded OMB, L, Z Z. Please help us decide which one is appropriate. Here’s a copy of the report thank you so they didn’t irrigation and department of the right septic hip joint. There is a coding clinic about minimal debridement along with the drainage procedure of the hip. In this case they did do an excision procedure. If we take a look, they did a capsule autonomy, which is an incision into the capsule than they did. They found this can liquid, and then I collected the cultures, and then I elevated the CAHPS on the bodged and then I completed, A, CAHPS selected me. So a capsule or the capsule is within the joint itself. So to me, I would be coding. The hip joint, I would be coding excision of the hip.
51:52 That is the capsule is, is, Is the hip, right? It’s the capital CAHPS, So it was a joint structure. So, be coding, excision of right hip joint open, approach is the correct advice.
52:12 And, finally, we have our reference pages. For all of the things that we discuss today, there’s quite a few of these, if you’re interested, These are all the ones that I’ve referenced to some degree during the presentation.
52:31 OK.
52:34 OK, so next up, I have another procedure. Going to the left frontal and so fellow seal, skull base defect repair.
52:44 Moving on from that. And then I’ll answer questions at the end.
52:49 So, we have our first I guess it’s important that we understand what an encephalitis seal is and typically, it does. It is a congenital anomaly, when the neural tube does not fully close. And this happens when the baby’s brain nervous system and school are first starting to form. and it doesn’t close, it can cause a sack like bulge with brain tissue and spinal fluid that poke through the skull. So, you can see the nasal frontal encephalitis seal there on the left … and … on the right And these are the two most common. There are other ones. I do have a link there, where I got these pictures from. There’s more information there, if you’re interested.
53:34 Most, again, most of them occur in these two places. Again, there are different types other than the ones listed on this slide.
53:43 I want to talk about acquired defects, So a lot of the reports that we see are actually acquired defects. So depending on how you index this acquired an NGO seal, it says, see spinal bifida, if it’s involves the spine. Acquired would be G 96, 198, and then, cerebral would be C and ….
54:05 You see encephalitis Seal, and it takes you to congenital.
54:11 We have we know some of the cases we have. We have specific documentation that these are acquired defects and not congenital defects.
54:19 So you can see acquired from an NGO seal is G 96, 198, and cerebral is …. So to me, there’s a little bit of a problem with it with the index here. Should we be using other disorders of … or other specific specified disorders of the brain? That’s the question that was my thought after doing a little bit more research that they’re not truly It does include cerebrum Anand … here.
54:50 This is something I’m probably going to submit because it kind of it kind of doesn’t make sense to me to use the congenital code.
54:58 So this is just a thought that I had it. You know, it is a roundtable. Let me know your thoughts, if you guys, if you guys code this. Do you use other disorders or other specified disorders of the brain if it involves the …, or involves the brain and the menin Gs? Or do you simply go with the encephalitis seal the congenital code?
55:20 Um.
55:24 Let me go back here. Oops.
55:27 Sorry. I skipped ahead.
55:32 So I’m an NGO seal, is a protrusion of only the … and … cerebral spinal fluid. And then … is a protrusion of the … CSF, fluid and brain tissue. So a little bit different.
55:45 Where we have just the … versus the brain. Again, I’m questioning this just because it’s not a congenital code.
55:55 So I have one person saying that they would probably go with the acquired or other disorder of the …
56:01 for this, again, that’s up in the air.
56:04 They see the specific documentation that I have, I think it was due to sinusitis and it create a defect in the skull base, so what we saw in those pictures of the babies basically applied to this patient, adult patient. They had a defect, Judith Sinusitis, and it created this bulge of tissue through the defect and created this encephalitis seal.
56:27 So it’s a little bit I’m a little bit pressed. I don’t want to use a congenital code for that when it’s specifically documented as non congenital. So, that’s kind of what we came up with. Is it correct? I don’t I don’t know.
56:41 But I just wanted to throw that out there as an issue with coding these acquired defects.
56:49 Can you query for clarification of congenital? for? Versus acquired, I would say, I would say, yes.
56:55 Specifically, when it’s adult patients, they typically will say the cause, not always, but they do say, typically, the baby, when a baby presents with this, that it’s going to be repaired right away, but, you know, it’s, it is a, it is a high risk issue.
57:14 So, if the patient, I mean, I guess it could still be congenital if it didn’t progress to the point where it was visual visual visual.
57:23 But typically, an adult patient, it’s probably not going to be congenital. But if you think, if it’s possible, you can query for that. But again, I don’t know if coating of the non congenital code is correct. Because if you go to the Index for Milo … or … Seal, they all take you to the congenital codes.
57:42 So that’s a problem that I do have with coding these.
57:46 Um.
57:47 But let’s take a look at the op report, encoding the procedure.
57:51 That’s a question that’s still out there on these, and that’s why I always ask that you submit your questions to Coding Clinic or whatever organization that you use for coding questions. I know some people submit to three M, et cetera.
58:09 To me, the co-operating Parties is probably the most, is probably the most appropriate for submission of those type of questions.
58:18 But I’m leaning more toward the Acquired the Acquired or other Disorder of Eminent Men, and men and Josie, or …, or Brain. When it comes to an Acquired Defect? So we have this operation. This left Frontal Craniotomy of Repair of encephalitis seal and school based effect They washed out and repaired than … seal, and what does it mean? You go?
58:40 See also, Amigo Seal, we’ll talk about that in a second.
58:46 It’s that mucus.
58:46 It’s that mucus in the, and in this case, it’s in the sinus or assist of the nose and sinus, sorry.
58:59 And they also have to remove that. So they decompress the left orbit from the mucosal, it’s extending into the orbital tissue. Then they removed the mucosal, mucosa unpacking enclosure of the left frontal sinus. So let’s take a look about exactly what they do: The indication that patient has a mucosa over the left orbit, and … through the interior sculpt base in the frontal sinus.
59:26 So taking a look at this, we have a lot of, you know, they’re setting up this patient, they’re incubating them. They make an incision in the muscle.
59:34 In this they create a skin flap and they political allies, the pretty hairy cranial graft was in harvest it and reflect it. They did use a burr hole to get into the brain. The Dura was stripped. The remainder of the craniotomy was performed with the Footplate drill.
59:50 They they got some hemo status there, the dura was left open or closed and we dissect it along into your faucet down to the roof of the orbit and obvious and …. So this is where it’s protruding through the orbit. At this point. We found an obvious journal defect within … eroding through the skull base into the frontal sinus. So it’s kind of involving multiple areas here.
60:12 This was carefully dissect it. And the defect was truncate it in the Dura, and Brain retracted posteriorly.
60:18 At this point we then evacuated this SFO seal defect into the school base and made our way into the frontal sinus, The frontal sinus was, then carefully cure cure taught to read it. And stripped of all, it’s me, Kosovo, as you can see there there in the frontal scientists at that point. and they curate, they stripped the mucosal or the mucosal there.
60:36 There is a very large mucosal extending into the left orbit carefully.
60:40 In order to better remove this, we then did we did drill a very small amount carefully of the interior school base for the roof of the orbit, and this allowed for us better access to this and remove this, all the mucus, as well as the mucosal lining was all removed without complication.
60:56 And then they continue to do the mucosal stripping in the left frontal sinus, and then we see they reset it to encephalopathy, Amico seal, and perform the decompression. They then sprayed the defect with bio glue, and then they carefully repaired the … defect as best they could with a suture.
61:16 That Gerald Defect, if we refer back to that, was from the …. So, they’re referring, refer, repairing that … area that was created from the …. They then … the …
61:27 flap and latest over the entire defects, so they’re supplementing that area.
61:32 Then, they also replace that bone, and, with the plating system, so, which part of that is part of closure, and which part of that is an additional, an additional bomb repair. So, if we think about closure, that bone plating, they’re gonna have, that’s part of the procedure, but they did replace a deed to repair the defect.
61:51 The TensorFlow seal Defect, they did replace that pair of cranial flops so, to me, I’m going to be coding that the plating system, they have to put the bone back into place, so that’s considered normal, normal part of closure in that case. So, let’s take a look.
62:07 They talked about extension of the left orbit, releasing and decompressing, the orbit by excision, and for drilling and removal of the mucosal tissue extending into the orbit …. And I have that area highlighted. So we do recommend that, and I’ll talk about a coding clinic when they do an excision. And when they do a release or decompression procedure but they excised tissue for that release and decompression. I’ll talk about that in just a second.
62:34 They did repair the cerebral …, they dissected it, and then it retract it, and then they repair the defect. So, we’re suggesting coding repair cerebral … for the repair of the …
62:45 defect created by the encephalitis … We have the transfer of the face … tissue and fascia for the closed closure of the defect for the muscle cutaneous, skin flap Pelican, eyes pair cranial graph that was harvest harvested and laid over the entire area. And then we have extirpation of matter from the left frontal sinus for the stripping of the mucosal from the frontal sinus.
63:12 And let’s take a look at decompression of a … malformation by excision. So it’s not exactly the same, but the patient was admitted for Suboxone Cipro Craniectomy and Lemon Ectomy for the … decompression with … and reduction. Of the Chancellor Size Addiction, a dissection was made down in including this occipital bone. The Craniectomy was performed alum Anatomy, was performed the dura, was opened in the bilateral. Tonsils. Hurried. Past the form of Magnum as well, as the spinal sensory nerves, are visualized decompression of the nerves was achieved by shrinking the tonsils on the left side using bipolar suction A portion of the left tonsil was receptive.
63:51 Then on the right side the tonsils shrunken down using bipolar electro … after concert confirming tonsil reduction, and being able to visualize the fourth ventricular outflow and … patch was placed in a site was closed.
64:03 So you could see here how do they co decompression by excision? They they suggested coding excision of cerebellum open approach for the excision of the cerebellar tonsils and they coded destruction for the shrinking of the Tonsil. And then they coded supplement for the Dura mater with Nano … tissue substitute. So we didn’t go with supplement, in our case or destruction. They didn’t do any shrinking of anything. We didn’t go, it’s supplement. They just repaired it with suture.
64:32 Then they put a different type of graft over it. So that was why we went with with those codes.
64:43 OK, so I know I’m a little bit over so I’m going to end it here for a bonus. I do have a body part case about coding, the colon anatomy from excision to resection of the large intestine.
64:55 It’s very simple and you can walk through it, You can go over on another, another roundtable as well. So, just a bonus here.
65:07 So if they’re doing a, elio collect them, either making incision at the terminal Liam. There, for the, For the, they made it an incision. If you’ve read the report at the middle transverse colon, what makes up the right colon? Is the, the, the the right half of the transverse colon descending colon the …, the appendix if they still have their appendix and then a terminal …? So this was all size In this case the coder coded this to excision. But if we follow our definition of our our root operation for resection. It’s the entire right colon that was XI. So this should have been color coded to resection of right colon instead of excision.
65:44 So just summing that up real quick, on what’s going on with this, you could see the definition of right and left colon there are root operation guidelines. And that specific case, I know someone was going to say something about the hand assisted.
65:57 We still have our guidelines for hand assisted open approach. With percutaneous endoscopic, assistant, laparoscopic assistant, we have to be careful. Is it really laparoscopic went with them, extending the extension to remove the body part or to do the … or is it truly an open approach with a gel port or a hand poor and I go over that in in the, in the information below.
66:22 So, just a reminder, thank you, of course, for attending our webinar. You can download your CEU. I have the link here. You have two weeks to download it.
66:33 If you’re a CX employee, please refer to the Yammer group for guidelines and more information about CEUs.
66:41 And I will stay on for a couple of minutes to answer any other questions that I did not get to, but thanks again as always for attending. And everyone, have a great rest of your week.
66:53 So, I just mentioned, someone’s asking about the CEU I have the information on the slide. The link to the CEU can be downloaded using that link. We also get an e-mail if, if you want to wait for the e-mail, you can also download the e-mail. Please give us a minute to upload the CU if it’s not already uploaded, before you e-mail us, Sometimes it takes a little bit of time to get that uploaded.
67:21 Thanks, everyone.
67:29 So, just going back to our … case, most people are saying they would use the … 96 case, G 96 code, it seems more appropriate secondary, not a primary condition. So, of course, if we’re not sure if it’s, if it’s a congenital versus acquired, you can inquiry. That’s good. That’s sometimes those conditions can be, you know, not necessarily for this, but for other conditions. We don’t know if it’s congenital or acquired. So, we may need to query for that.
67:54 Um.
68:01 So someone’s asking if they can have the coding advice for those debridement.
68:07 Yes, I can. I can give you the notes section. Donna, if you, if you’re still here, if you want to send me an e-mail, I can send you the verbiage.
68:18 It’s kind of just to get everyone thinking, I didn’t include that information for a specific reason. Just to have everyone kind of think through the critical thinking stage of that, but if you do want that information, I can supply that.
68:35 So, Ashley, I’ve submitted a few questions to Coding Clinic about how to code drainage, she’s done with the present and the response, where to get both to code both, so Actually, I don’t know if you could send those to me, but that would be great.
68:57 Yeah, so I have a lot of questions about the incision and drainage and debridement. I think that’s something that still needs to be clarified. I was referring to coding clinics that we already have in place that state, if it’s the same site, the more definitive procedure would be coded. I didn’t, I haven’t seen anything published that says, both would be coded.
69:18 I mean, to me, it does make sense to code. At times, when they say, if there’s two separate intents, maybe they have an abscess, and they also have … tissue in another area. But the same site. I mean, it depends on the documentation, but based on the current advice that’s given, I would only code the most definitive procedure. That’s kind of the the thing that’s kind of been in question and like I said, sometimes the facilities will query if it’s not clear which one was the definitive procedure they will query for which, when the doctor fields is the most definitive procedure, if it’s if it’s a debriefing of the same site as the abscess.
70:00 So, of course, someone’s saying different objectives but we see a lot of times where they do an incision and drainage and then they just clean up the edges of the abscess. Would that be considered a definitive debridement. Probably not.
70:13 So, in some cases, I think the incision and drainage is the definitive procedure, and sometimes it’s the debridement.
70:37 OK, so good points so not all departments include abscess.
70:45 OK, so going back to Coding Clinic, when they say down to bone, that includes bone.
70:54 They have to say, down to and including bone. Right? Not just down to bone.
71:01 So as you can see from some of these comments, it’s still something that we have a, kind of another issue we have with coding Debridement.
71:14 I think that’s all the questions that I have, But I think I’m gonna submit some of these two based on some of the responses. I think they’re still a little bit of.
71:24 Confusion regarding, know, the intent of the debridement.
71:29 If it’s drainage and debridement, maybe some of these examples will help, Hopefully, they publish them, some like someone said, I think it was Ashley. She said that she submitted them to Coding Clinic and they said The Code both, I haven’t seen that. So, I wish they would officially published some of these things, except especially things that cause confusion for us. So, thank you for everyone’s insights. Some of the same things that we struggle with, it looks like other people are struggling with, we do our best, right? We want to follow our current advice that’s out there, and make the best issues and decisions we can. So hopefully we can get some of these cleared up, and maybe we can revisit this when I get some more information.
72:11 But thank you for sharing your insights as well.
72:16 OK, so that’s all I have for today.
72:21 As I mentioned, that the current one may not be up yet. You need to wait, you may need to wait. I would wait until tomorrow morning at the, at the latest or earliest.
72:30 You, an e-mail will go out so I would wait.
72:35 And if there’s an issue with it, we’ll get it fixed.
72:38 Um.
72:41 Thank you so much. All right, guys, take care. Happy you have a good week.
72:46 See you next time. Bye.
72:48 Right.