Medical Coding for Pressure Ulcers - CPT and ICD-10-CM with case example

Contempo Coding
8 Dec 202220:14
EducationalLearning
32 Likes 10 Comments

TLDRIn this informative video, Victoria, a medical coder and educator, delves into the intricacies of medical coding for pressure ulcers. She explains the importance of correctly identifying the ulcer type and stage using ICD-10-CM codes, highlighting the difference between pressure ulcers and other types of ulcers. Victoria also discusses the coding of surgical treatments, such as debridements and skin grafts, emphasizing the need for accurate documentation and the use of specific terminology to ensure proper classification and reimbursement. A practical case study is provided to illustrate the coding process for a non-healing decubitus ulcer and its debridement, offering valuable insights for medical coders.

Takeaways
  • 📚 Medical coding for pressure ulcers involves using ICD-10-CM and CPT codes, with a focus on accurate documentation and stage identification.
  • 🧠 Pressure ulcers, also known as decubitus ulcers or bed sores, result from prolonged pressure on the skin and subcutaneous tissues.
  • 🔍 ICD-10-CM codes for pressure ulcers are found under 'Ulcer' and 'Pressure' in the alphabetic index, leading to the L89 section.
  • 📈 Pressure ulcers are categorized by location and stage, with stages ranging from one (mildest) to four (most severe), plus unstageable and deep tissue injury categories.
  • 🏥 Inpatient coding guidelines specify that while other clinicians can document ulcer stages, the associated diagnosis must be documented by the patient's provider.
  • 💻 When multiple pressure ulcers are present, each should be coded separately to fully capture the extent of the injuries.
  • 🔑 The term 'wound' in medical records can map to different ICD-10-CM codes than 'pressure ulcer', so consistent terminology is crucial.
  • 🌟 Surgical treatments for pressure ulcers include debridements, excisions, flap closures, and skin grafts, each with specific CPT codes.
  • 📊 Debridement codes are based on the type of tissue involved (subcutaneous or muscle) and the size and depth of the area treated.
  • 🔢 Calculating the correct coding units for procedures like skin grafts requires attention to the size and location of the graft.
  • 📝 A case study is provided to illustrate the application of ICD-10-CM and CPT codes for a patient with a non-healing pressure ulcer and debridement.
Q & A

  • What are pressure ulcers also known as?

    -Pressure ulcers are also known as decubitus ulcers or bed sores.

  • What type of patients are more prone to developing pressure ulcers?

    -Patients who are disabled and may sit in their wheelchairs or lay in bed for prolonged periods are more prone to developing pressure ulcers.

  • How can pressure ulcers be prevented?

    -Pressure ulcers can be prevented by regularly moving and rotating patients, and sometimes using special mattresses to relieve pressure.

  • What is the ICD-10-CM code range for pressure ulcers?

    -The ICD-10-CM code range for pressure ulcers is L89.

  • What are the different stages of pressure ulcers?

    -The stages of pressure ulcers are: stage one (red and warm to the touch), stage two (damaged with open sores or blisters), stage three (crater-like appearance), stage four (severely damaged with large wounds), unstageable (stage not clear), and deep tissue injury.

  • What is the significance of the 'unspecified' stage in pressure ulcers?

    -The 'unspecified' stage means that the provider did not document the stage of the ulcer, which is different from 'unstageable' where the stage is assessed but cannot be determined.

  • What are the ICD-10-CM guidelines for documenting pressure ulcer stages by non-physician clinicians?

    -Non-physician clinicians, such as wound care nurses, can document the stage of an ulcer, but the associated diagnosis must be documented by the patient's provider.

  • How can multiple pressure ulcers be coded?

    -If a patient has multiple pressure ulcers, each ulcer can be coded separately using the appropriate ICD-10-CM codes to capture all of the patient's injuries and their extent.

  • What is the difference between a wound and a pressure ulcer in ICD-10-CM coding?

    -In ICD-10-CM, a wound maps to a different code than a pressure ulcer. The terminology must be consistent and documented correctly to classify it properly with the code sets.

  • What are some surgical treatments for pressure ulcers?

    -Some surgical treatments for pressure ulcers include debridements, excisions, flap closures, and skin grafts.

  • How are debridement procedures coded in CPT?

    -Debridement procedures are coded in CPT using codes 97597 through 97602 for superficial layers and 11042 through 11046 for subcutaneous and muscle tissue, which are broken down by size and depth.

  • What is the process for calculating the units for CPT codes related to skin grafts?

    -The process for calculating units for skin grafts involves determining the type of graft, the size of the graft, and the location of the graft. The size is calculated in square centimeters and then converted to units based on the specific CPT codes and guidelines.

Outlines
00:00
📚 Introduction to Medical Coding for Pressure Ulcers

The video begins with Victoria, a medical coder, auditor, and educator, introducing the topic of medical coding for pressure ulcers. She explains that pressure ulcers, also known as decubitus ulcers or bed sores, are injuries caused by prolonged pressure against the skin and subcutaneous tissues. Victoria emphasizes the importance of preventing these ulcers, especially in patients who are bedridden or using wheelchairs for extended periods. She also mentions that the video will cover ICD-10 and CPT coding, as well as a case study for practice. Victoria encourages viewers to subscribe for updates on new episodes.

05:03
📖 ICD-10-CM Coding Guidelines for Pressure Ulcers

In this section, Victoria delves into the specifics of ICD-10-CM coding for pressure ulcers. She explains how to find the correct codes in the ICD-10-CM book by looking up 'ulcer' and then 'pressure.' She clarifies that pressure ulcers are categorized by location and stage, with stages ranging from one to four, unstageable, and deep tissue injury. Victoria also discusses the importance of using the correct terminology when documenting pressure ulcers, as 'wound' and 'ulcer' are coded differently. She stresses the need for provider documentation for associated diagnoses and the necessity of querying providers in case of conflicting information in medical records.

10:04
🩺 Surgical Treatments and CPT Coding for Pressure Ulcers

Victoria discusses various surgical treatments for pressure ulcers, such as debridements, and provides the corresponding CPT codes. She explains the difference between superficial and deep debridements and how to calculate the correct codes based on the size and depth of the tissue removed. Victoria also covers excision codes, highlighting the distinction between debridement and excision. She touches on the complexity of coding for skin grafts, mentioning a separate video dedicated to this topic, and emphasizes the importance of accurate documentation and calculation for proper coding.

15:05
📋 Case Study: Coding for a Left Ischial Pressure Ulcer

Victoria presents a case study involving a patient with a non-healing pressure ulcer in the left ischial region. She demonstrates how to identify the correct ICD-10-CM code for the ulcer (L89.229) and how to code for the debridement procedure (11042 and 11045) based on the size of the ulcer. Victoria uses the case study to illustrate the process of coding for pressure ulcers, including the addition of unspecified stage when the stage is not provided. She also reiterates the importance of understanding anatomy for accurate coding, as 'ischium' refers to the hip.

20:07
🎙️ Closing Remarks and Future Content Tease

In the conclusion of the video, Victoria wraps up the discussion on pressure ulcer coding and encourages viewers to explore more resources on her channel, including a dedicated video on skin grafts. She playfully suggests the idea of creating an audio version of herself reading the ICD-10-CM guidelines and invites viewer feedback on this concept. Victoria also teases future content, including more case studies and coding tips, and signs off with an encouraging message for viewers to continue their coding journey.

Mindmap
Keywords
💡Medical Coding
Medical coding refers to the process of converting healthcare procedures, diagnoses, and other medical information into universal alphanumeric codes. In the context of this video, medical coding is the central theme, focusing on the specific coding for pressure ulcers, which is essential for accurate billing and record-keeping in healthcare.
💡Pressure Ulcers
Pressure ulcers, also known as decubitus ulcers or bed sores, are injuries to the skin and underlying tissue caused by prolonged pressure. They often occur in patients who are bedridden or in wheelchairs for extended periods. The video emphasizes the importance of proper coding for these conditions to ensure appropriate treatment and insurance claims.
💡ICD-10-CM
ICD-10-CM stands for the International Classification of Diseases, 10th Revision, Clinical Modification. It is a coding system used in the United States for documenting diagnoses and procedures in medical records. The video provides an in-depth look at how to use ICD-10-CM codes for pressure ulcers, including the specific sections and additional characters needed for accurate coding.
💡CPT Codes
CPT Codes, or Current Procedural Terminology codes, are a standardized set of codes used to report medical procedures and services to insurance companies. In the video, CPT codes are discussed in relation to the treatment of pressure ulcers, such as debridement and possible surgical interventions.
💡Staging of Pressure Ulcers
The staging of pressure ulcers is a classification system that describes the severity and depth of the ulcer. Stages range from one to four, with unstageable and deep tissue injury categories also recognized. Accurate staging is crucial for determining the appropriate treatment and for coding purposes.
💡Debridement
Debridement is a surgical procedure that involves the removal of dead or damaged tissue from a wound. In the context of pressure ulcers, debridement is an essential step in the healing process and is coded using specific CPT codes based on the depth and size of the ulcer.
💡Coding Guidelines
Coding guidelines are the rules and standards that dictate how medical coders should document and report diagnoses and procedures. These guidelines ensure consistency and accuracy in medical coding, which is critical for patient care and insurance reimbursement.
💡Wound Care Nurse
A wound care nurse is a healthcare professional who specializes in the assessment and treatment of wounds, including pressure ulcers. While they can document the stage of an ulcer, the associated diagnosis must be documented by the patient's provider for coding and billing purposes.
💡Unspecified Stage
An unspecified stage in the context of pressure ulcers means that the provider did not specify the stage of the ulcer in the medical record. This lack of documentation can lead to the use of an unspecified code, which may not accurately reflect the severity of the ulcer.
💡Medical Record
A medical record is a detailed history of a patient's health information, including diagnoses, treatments, and other healthcare services received. Accurate and complete medical records are essential for medical coding, as they provide the necessary information to assign the correct codes for billing and treatment planning.
💡Skin Grafts
Skin grafts are surgical procedures where skin is transplanted from one area of the body to another to cover a wound or ulcer. They are used in the treatment of pressure ulcers and require specific coding based on the type, size, and location of the graft.
Highlights

Discussion on medical coding for pressure ulcers

Introduction to Victoria, a medical coder auditor, educator, and content creator

Explanation of pressure ulcers, also known as decubitus ulcers or bed sores

Importance of patient movement to prevent pressure ulcers

Coding for pressure ulcers using ICD-10-CM codes

Differentiation between non-pressure and pressure ulcer codes in ICD-10-CM

Explanation of pressure ulcer stages and their coding

Use of combination codes for pressure ulcers that include cause, location, and stage

Clarification on the difference between 'unstageable' and 'unspecified' pressure ulcers

Guidelines for documenting pressure ulcer stages by clinicians other than the patient's provider

Coding for multiple pressure ulcers and the use of multiple codes to capture all injuries

Differences in coding between wounds and pressure ulcers

Overview of surgical treatments for pressure ulcers, including debridements

Coding for debridement using CPT codes 97597 through 97602 and 11042 through 11046

Explanation of how to calculate square centimeters for coding purposes

Discussion on the coding of excisions, flaps, and skin grafts for pressure ulcers

Presentation of a case study for coding pressure ulcers and debridement

Final coding example for a left ischial pressure ulcer with debridement

Transcripts

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