How Much Do YOU Know About Debridement?
October 31, 2007
Study the examples of wounds, debridement action taken, practitioner delivering care, and tissue removed. Assume the care facility is a hospital-owned outpatient wound department (HOPD). Then determine the type of debridement, documentation, and coding.
Understand that in actual practice, you would have a great deal more information about the patient in your care — eg, medications, nutritional status, previous treatment, and vascular status.Also, the information given may not match the exact history of the patients in the pictures; it was compiled to illustrate particular scenarios.
Discuss these cases with your clinical group.Then, please share your answers with TWC.Take a few moments to email your responses to our Editor at twc@hmpcommunications.com.
Learn.We created this exercise to point out the daily challenges and often difficult choices we face in our clinics and to emphasize the ongoing need to critically examine each situation and make the best decision possible based on best-practice health and regulatory protocols.Although the patient stories may be manufactured, the opportunity to assess your level of debridement know-how is a valuable exercise, even for experienced clinicians. Now, pencils ready ………. begin.
Patient 1. A 64-year-old patient with large abdominal wound following surgery for a bowel perforation presented with mixed tissue types including granulation tissue as well as devitalized subcutaneous fat. The wound care nurse decided to utilize a papain-urea preparation to liquefy and remove the devitalized fat in preparation for negative pressure wound therapy. The wound measures >20 cm2. How would you code for this procedure?
Patient 2. A 32-year-old, patient with type 1 diabetes presented with dehisced, non-healing post-op incisions to both feet on the right fourth metatarsal head and left second metatarsal head, respectively. Wound edges were macerated and wound surfaces were covered with adherent devitalized fibrinous material. The patient was insensate. The physician wrote an order for the certified wound care clinician to perform conservative sharp debridement of both wounds. The nurse used scissors, forceps, and a curette and controlled the minimal bleeding with pressure and silver nitrate. What type of debridement did the clinician perform? What code should be assigned?
Patient 3. On initial visit, a patient presented with non-healing fifth ray amputation site. Previous treatment included gauze dressings under suction. The wound now had hypergranulation tissue with a fibrinous film coating. The physician administered a topical anesthetic and used low-frequency contact ultrasound to debride the fibrin from the surface of the wound. The minor bleeding stopped with pressure. Ultrasonic debridement resulted in a robust granular bed measuring 8.0 cm x 4.0 cm. What code represents this work?
Patient 4. A patient with diabetes presented with a soft, fluctuant callous on the plantar aspect of the foot at the fourth metatarsal head. After the physician used a scalpel and forceps to remove the calloused blister roof and skin, all necrotic subcutaneous tissue was excised. After the debridement, the physician explored the wound and ultimately probed to bone. What depth of debridement was performed? What code is appropriate?
Patient 5A. An elderly woman presented with a painful lower extremity ulcer of 6 months’ duration that was covered in adherent moist devitalized tissue. The ulcer had never been debrided. After administering topical anesthesia and oral pain medication, the physician used a curette to excise all of the devitalized skin and subcutaneous tissue, including spicules of calcium. The physician stopped excising when healthier, bleeding tissue was uncovered. What type of debridement was performed? What code should be assigned?
Patient 5B. The patient returned in 2 weeks with a thick film of fibrin adherent to the surface of the wound. After administering a topical anesthetic, the physician used a scalpel to excise the wound surface into healthy bleeding tissue below. The wound still extended into subcutaneous tissue. What type of debridement was performed? What is the appropriate code?
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