Comments on #2 questions and what I missed on this scenario

Discussion in 'Medical Coding & Reimbursement Discussion' started by Sparky, Dec 18, 2012.

  1. Sparky

    Sparky Well-Known Member

    Thanking you in advance for your comments and suggestions. I really have to work on this area.......
    17. Provide the CPT and ICD-9 diagnosis codes for the following scenario.

    INDICATIONS: The patient had a YV advancement flap and advancement of the hamstring muscles about 3 weeks ago, but the wound separated and the muscles retracted over the area of the bone. She has had moderate separation of the wound but not complete separation, and we plan to minimally debride this area and resuture the wound with tension sutures.

    DIAGNOSIS: Wound dehiscence, left ischial area, partial.

    SURGICAL FINDINGS: A 6 cm long by about 4 cm deep wound dehiscence.

    PROCEDURE PERFORMED: Debridement of ischial wound by curettage with secondary wound closure.

    PROCEDURE: The patient was intubated and turned in the prone position. The area was prepped with Betadine scrub and solution and draped in routine sterile fashion. The area was curettaged and a piece of the tissue was placed in a culture tube. This was curettaged down to bleeding granulation tissue. I was reluctant to restart by complete debridement of all these areas, because there are factors operative in this wound that are probably beyond our control. We nevertheless completed debridement of the granulation down to bleeding tissue and put far/near, near/far tension type sutures in the wound using #2 Ethibond. I then put some Xeroform underneath the sutures that were holding the wound together and put three boxes
    of Kerlix Fluffs on top of this to cover some of the open areas on the thigh. The thigh sutures were also removed. I then taped the three boxes of Kerlix Fluffs to the ischial area with Elastoplast and taped around the leg to hold this in place, placing an ABD pad over the open areas where the sutures had been present. I then taped the buttock and leg up on the lumbar area with Elastoplast in such a manner as to support the ischial closure. A home health care nurse was in attendance at this time, and she was advised as to how to retape and dress this on a daily basis.

    The patient had two open areas of the thigh and right lower leg, one of which was a donor site, the other of which was an old skin graft with open areas. We applied Scarlet Red and ABD pads to this area. Estimated blood loss 50 cc. Otherwise, the patient tolerated the procedure well and left the area in good condition.

    Answer: CPT Code: 97602
    Answer: ICD-9-CM Code: 998.31, 13160 (Comments: Incorrect code in red)
     
  2. Laureen

    Laureen Queen Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    Hi Sparky,

    Where was this #17 question/scenerio taken from? Also can you tell us more of your thought process as to why you feel the codes in red are wrong. Or better yet what do YOU think the correct codes are and we can go from there. Thanks!
     
  3. Sparky

    Sparky Well-Known Member

    Hi Laureen, I had a quick break here at work......the question came from my Penn Foster exam for Medical Coding 1 which I just completed. I read my book, research online and went back to my book before I finalized my answers. I felt I made the rigth choice with my gut instinct, but still doubted myself. The school graded in "RED" and stated incorrect answer. I was given a reference list to review but no detail explaination on why I my answers were incorrct. I want to be comfortable with reading case studies and different scenarios and make the right choice in coding correctly. Please help
     
  4. Laureen

    Laureen Queen Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    I agree with code 13160 for the procedure. Here is what my Findacode encoder shows me for that code

    13160 - Secondary closure of surgical wound or dehiscence, extensive or complicated​

    Plain English Description
    Secondary closure of an extensive or complicated surgical wound or wound dehiscence is performed. This procedure covers two scenarios, one in which the surgical wound is not closed at the time of the original surgical procedure and another in which a surgically closed wound opens along the previous suture line. Secondary surgical wound closure is performed on a date subsequent to the original surgical procedure during a separate surgical session or encounter. The edges of the open surgical wound are trimmed. The deepest layers may be closed with absorbable sutures and the knot buried followed by closure of superficial layers with non-absorbable sutures. If retention sutures are used to hold the edges of the wound together without tension, they are placed through the entire thickness of the wound, a short length of plastic or rubber tubing is threaded over each suture and each suture is then tied. Stents may also be used to hold tissue in place or maintain the opening of an orifice. Care is taken to carefully align wound edges to prevent scar depression. Secondary closure of a wound dehiscence is performed on a wound that has opened at the site of the earlier repair. The extent of the wound dehiscence is evaluated. The wound is irrigated with sterile saline or an antibiotic solution. The previously placed sutures are removed and the edges of the wound are trimmed. Any necrotic tissue is debrided. The wound is then repaired as described above.​

    So I feel the debridement is bundled into the 13160 code.

    As far as the diagnosis goes the index shows

    [​IMG]

    So the question is is it deep or internal for 998.31 vs. the unspecified or superficial (i.e.. skin) code 998.32. When I read it it does not sound as if it is deep. So I would go with the 998.32.

    [​IMG]


    [​IMG]

    My final answer: 13160 with 998.32
     
  5. Sparky

    Sparky Well-Known Member

    Laureen, again thank you so much. I am making mental notes and will use the techniques you have described in your explainantion. I will try to incorporate these in future screnarios and practice, practice, practice. I will keep you posted on how I am doing with this and if I have additional questions.
     
  6. Alicia Scott

    Alicia Scott Moderator, CCO Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    I agree with Laureen on this. I can see what you were thinking with your answers. This is a question that is typical of wanting to teach how to look at the details. It is easy to get caught up in all the information but like Laureen mentions for the dx code. 998.32 vs. 998.31 is a big deal. There is no mention of it being deep or internal.

    Something I tell my students and I hope this helps. When you are taking an exam if you know which section you are testing in keep in mind that they are going to ask you questions specific to those guidelines. Don't let the other issues in an op report confuse you. This is easier with the CPC exam because they give you the section titles like Integumentary. Then you know to keep your eye out for terms like "deep", "necrotic", "complicated" etc. Those terms define and or change codes. Once you have done this for a while those words will JUMP off of a report for you.
     
  7. Sparky

    Sparky Well-Known Member

    Alicia, thank you. Again I will make notes and will keep in mind the different scenarios and remember the guidelines for that specific question. Yes, I will definitely practice, practice, practice - I have to find more examples to work with on daily basis. I will be investing in products from Laureen and work hard. Thank you both for all your help and support. I will keep you posted on my journey.
     
  8. jsclward

    jsclward Member

    I'm working on this exam now also. Wouldn't you need to list code E878.9 for abnormal reaction to surgery also? If not, why?
     
  9. Alicia Scott

    Alicia Scott Moderator, CCO Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    E codes are only on initial visits.
     
  10. jsclward

    jsclward Member

    Ah, that's right, now I remember! Thank you so much for clarifying that!
     
  11. jsclward

    jsclward Member

    Wait, I just realized the E code I used was for the abnormal reaction to a surgery. Do I still not need it?
     
  12. Alicia Scott

    Alicia Scott Moderator, CCO Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    No trouble. You have a good eye to catch that. Another thing to note for ICD-10. There will not be Ecodes like there are now. They will be embedded into the code more or less. So the Ecode will follow the case which I think is a good thing for continuing of care.
     
  13. jsclward

    jsclward Member

    So do I need to list it?
     
  14. Alicia Scott

    Alicia Scott Moderator, CCO Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    No, only for initial visits. :)
     
  15. jsclward

    jsclward Member

    Okay. I just did some more research and discovered pretty much that the 998.32 actually covers it, so the E code is not needed. Thank you so much for the feedback! I'm really trying to grasp all of this!
     
  16. Alicia Scott

    Alicia Scott Moderator, CCO Instructor Staff Member Administrator Moderator MTA Student Replay Cluber PPM Student (CPPM®) PBC Student (CPC®) Blitzer CCO Support Staff FBC Student (CPC-H®) ICD-10-CM Student

    It seems to me like you have a handle on it. You are doing everything right. The fact you are researching is excellent. That is what coders do. ;)
     

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