Debridement

Excisional Debridement Definition: The surgical removal or cutting away of devitalized tissue, necrosis, and slough.

Non-Excisional Debridement Definition: The nonoperative brushing, irrigating, scrubbing, or washing of devitalized tissue, necrosis, slough, or foreign material.

ICD-10 PCS Root Operations:

• Excision: cutting out/off without replacement, a portion of a body part
• Extraction: pulling or stripping out or off all or a portion of a body part
• Irrigation: putting in or on a cleansing substance
• Release: freeing a body part

Coding Considerations:

Review pertinent Coding Clinics such as:

• AHA Coding Clinic, Second Quarter 2023, p. 30 Excisional Debridement and Non-Excisional Debridement at Deeper Layer Same Site
• AHA Coding Clinic, First   Quarter 2023, p. 36 Maggot Therapy
• AHA Coding Clinic, Third Quarter 2023, p. 3 Excisional and Non-Excisional Debridement

Excisional Debridement’s are classified to the root operation ‘Excision’. Non-Excisional Debridement are generally classified to the root operation ‘Extraction’ except when the procedure is performed by irrigating the devitalized tissue. In those cases, the root operation would be ‘irrigation’; OR when non-excisional debridement is performed on a joint in which case the root operation is ‘Release’ (there is no body part value for ‘joint’ for the root operation ‘extraction’). When the debridement’s of multiple layers at the same time occur, assign only a code for the deepest layer of debridement. When both Excisional and Non-Excisional Debridement’s are performed on the same site, assign only the code for the Excisional Debridement.

CDI Practice Considerations

Review for medical comorbidities which include, but are not limited to:

• Sepsis
• Diabetes
• Circulatory Disorders such as PVD, chronic occlusions etc.
• Plegia’s: hemiplegia, quadriplegia, functional quadriplegia etc.
• Malnutrition

Examples of Non-Excisional Debridement include Versajet and utrasonic debridement. Using a ‘sharp instrument’ does not always equate to an excisional debridement performed. When reviewing for the intent of the procedure look for terms such as ‘excisional’, or ‘excision’ when describing an excisional debridement AND/OR the procedure description supports the root operation of cutting out without replacement, a portion of body part (see Coding Third Quarter, 2015 reference above for additional details).

Debridement PCS codes are classified by depth (see list below). Excisional debridement PCS codes often impact the MS-DRG. Depending on principal diagnosis, some Non-Excisional Debridement’s if done beyond the subcutaneous layer, impact the MS-DRG. Educate providers to use verbiage such as ‘down to and including’ when describing the depth debrided as this provides clear guidance of appropriate depth to assign. Ensure documentation supports accurate code assignment, query the provider for missing, ambiguous, or conflicting documentation. 

• Skin
• Subcutaneous tissue/Fascia
• Muscle
• Bone
• Joint
• Tendon
• Ligament/Bursa

Always review for accurate Principal Diagnosis. Query when missing, conflicting, and/or ambiguous documentation is present or clinical indicators support a more specific code, this can impact the MS-DRG assignment, when paired with debridement PCS codes.

When reviewing debridement documentation, think ADMIT

• A – appearance/size of wound (size of the wound before vs. after debridement, was the debridement carried down to healthy bleeding tissue, etc.)
• D – depth of the debridement (see list above)
• M – method used by the provider (brushing, cutting, trimming, etc.)
• I – instrument used (scalpel, scissors, curette, pulse lavage)
• T – tissue removed (necrosis, slough etc.)

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