Q: Can you code a burn based on descriptors (full-thickness, burns) or does the provider need to state the degree?
A: The O.C.G (Section I.C.19.d. Coding of Burns and Corrosions) notes ” Burns are classified by depth as first degree (erythema), second degree (blistering), and third-degree (full-thickness involvement).” If you see a full-thickness burn documented, I would code that to 3rd degree.
Q: From yesterday, I would like Terri to speak to the difference between Venous Stasis I87.8 and Venous Insufficiency I87.2 Providers seem to use these terms interchangeably. Thank you.
A: I agree – they do use them interchangeably. I would recommend a conversation with them. Let them know the conditions are coded differently and create a facility guideline based on that discussion. Ideally, they should be documenting a final diagnosis. Your guidelines could instruct coders that the final diagnosis will be what you code from when there is a discrepancy.
Q: The disruption of lower leg harvest site seems it would code to disruption of surgical wound and not just T81.30xa unspecified wound.
A: I agree. The index provides the description “Dehiscence of operation wound NOS” below T81.31.
Q: How do you code a wet to dry dressing?
A: 97602. See CPT Assistant, October 2016, Volume 26, Issue 10, page 3: Wound Debridement vs. Active Wound Care Management.
Q: With the O90.0 it’s not necessary to add any other ulcer code with this-correct?
A: I would not add any other codes unless they provided additional information about the patient’s condition. (Per O.C.G. Section IV.A.J: Code all documented conditions that coexist).
Q: The pt. is returning for treatment of the active ulcer of toe/foot and at that point the doc says it’s now healed and says return PRN. It was explained on another webinar you can use the Z51.89 with the ulcer code to indicate it’s now healed. Is this not correct and I should be using the codes you’ve identified?
A: The Z51.89, Encounter for other specified aftercare and the instructional note states “Code also condition requiring care”. Since there is no condition requiring care, I would use the Z09 code.
Q: Is the NPWT billable with both the 1104X and 97597?
A: No. Just with the 1104X debridement.
Q: If we have a nurse performing wound care if she is not certified, can we charge procedures and/or E/M levels? If so, what are the requirements we need to meet?
A: That’s typically captured by facility billing, unless it’s provided incident-to in a physician-based clinic. If that’s the case, they would have to meet all the requirements for incident-to, and the E/M for nurses is 99211. This is not applicable to a hospital OP department. For procedures, we would recommend taking a look at what is allowed per state licensure.
Q: Would you put the modifier 50 on 29580 if you put the Unna boot on both feet?
A: Yes. If an Unna boot is applied bilaterally, the modifier 50 is appropriate.
Q: If the patient was seen in Wound Care for dermatitis and the dermatitis was healed. Would you code Z09 along with Z782?
A: Yes. If no other condition is being treated, Z09 and Z87.2 would be appropriate. The instructional note under Z87.2 notes it is to be used for “Conditions classifiable to L00-L99” and since dermatitis is coded with L30.9, it falls under that category.
Terri Reid, CCS, CCS-P, CDIP, AHIMA-Approved ICD-10-CM/PCS Trainer
Senior Coding Quality Auditor
Terri comes to Haugen Group with 20+ years of health information management experience in coding, auditing, and education. She began her career coding emergency room records and wound care records where she helped develop coding and E/M protocols and met with the providers to help them improve their documentation. Terri transitioned to an auditing role when she realized how much she enjoyed sharing her coding knowledge and experiences with other coders to help improve their skills and confidence. Terri brings her expertise in coding and auditing to the Haugen Consulting Group, having worked in previous roles leading and performing inpatient and outpatient coding audits. She is passionate about learning new medical technology and how the disease process affects illnesses.