Depth and Location Key to Ulcer Reporting

Your dermatologist carries out a decubitus ulcer excision or debridement; here you will have to choose from about 25 possible codes. You will have an easier time selecting the right code if you are aware about the following:

Find out whether the wound closed. If so, by what method?

In some instances, the dermatologist may debride the ulcer and allow the wound to stay open to heal. On the other hand, the dermatologist may excise the ulcer, clear all infection, and close the wound. You need distinguish debridement from excision by what the documentation specifies, and not by the ulcer's removal.

Find out where the ulcer was.


There are nine ICD-9 codes for decubitus ulcers (707.00-707.09); with these options around, you now have many codes to choose from, specific to the ulcer's location on the body.
Find out how deep was the debridement.

You can report debridement (11040-11044) based on three different skin levels - partial thickness, full thickness, or subcutaneous -- or as deep as muscle or even bone. Say for instance, 11044 describes a debridement that involves chipping off pieces of diseased bone to get rid of the wound of infection.

A partial-thickness debridement includes the epidermis and part of the dermis, however some dermal cells are left. Normally the physician carries out these procedures using a scalpel or scissors, depending on the situation.

Find out whether anything else was excised besides ulcer.

In some cases, with coccygeal pressure sores the dermatologist may remove the coccyx to rid irritation and prevent the ulcer from recurring. The dermatologist may also excise bony remove the prominences during the same time as a pressure sore.

In yet another instance, if the dermatologist carries out an ostectomy during the excision of an ischial pressure ulcer, you should code 15941 if the wound was then closed with primary suture (15940) or with skin flap closure (15944).

Like always, your ability to answer these questions depends largely on the quality and specificity of documentation in the operative report.

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