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CDI Team: Excisional versus non-excisional debridement

Akron Children’s Clinical Documentation Improvement team has noticed an increase in the number of queries being sent to physicians regarding excisional and non-excisional debridement.

Dr. David Chand

Dr. David Chand

Coders cannot assume that the debridement of bone, fascia or muscle is always excisional. External auditors contend that providers must now state “excisional debridement of bone, fascia or muscle.”

The use of a sharp instrument does not always indicate that an excisional debridement was performed. Minor removal of loose fragments with scissors or using a sharp instrument to scrape away tissue is not an excisional debridement. When the type of debridement is not specified as “excisional,” it must be coded as a “non-excisional” debridement.

Definitions:

Non-Excisional debridement involves the nonoperative brushing, scrubbing, whirlpool or washing of devitalized tissue, necrosis or slough. Minor snipping also is included in the description.

Excisional Debridement requires the surgical removal or cutting away of necrotic or devitalized tissue. The word “excisional” must be in the medical record.

Additionally there must be documentation of:

  • Technique used (e.g. scrubbing, brushing, washing, trimming or excisional)
  • Instruments used (e.g. scissors, scalpel, curette, brushes, pulse lavage, etc.)
  • Nature of tissue removed (slough, necrosis, devitalized tissue, non-viable tissue)
  • Appearance and size of the wound (e.g. fresh bleeding tissue, viable tissue, etc.), and
  • Depth of the debridement (e.g. skin, fascia, subcutaneous tissue, soft tissue, muscle bone)
  • This is an ICD9/10 requirement and not a CPT requirement. 

Financial Impact:

A recent example highlights the financial impact of documenting accurately. By specifically stating “excisional debridement,” the case changed from a DRG 711 (post-operative infection) to a DRG 721 (post-operative infection with O.R. procedure).

As a result, the hospital received an additional reimbursement of $6,188.48. One word can indeed make a big difference.

About David Chand, MD

Dr. David Chand is a pediatric hospitalist and Lean Six Sigma deployment leader at Akron Children’s Hospital. He has a special interest in eliminating waste in healthcare and uses Lean Six Sigma principles to improve patient care and efficiency.

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