Cracking the Code
Overlapping Body Layers
When reviewing medical records pertaining to incision and drainage/excision procedures, it is very important for a coder to locate documentation supporting the depth of the procedure. For ICD-10-PCS procedure codes, there are different codes provided for incision and drainage of skin and incision and drainage of subcutaneous tissue and fascia. To ensure that a coder is selecting the most appropriate code, it is imperative to have a firm understanding of skin vs subcutaneous tissue.
The skin is the outer layer of the body. The subcutaneous tissue is the deepest layer underneath the skin. When coding incision and drainage/excision procedures, it is important to code to the deepest layer. If a provider’s documentation states that an incision and drainage/excision was performed on skin and subcutaneous tissue, then it is appropriate to report the PCS code for the subcutaneous layer.
Q: A surgeon performed an open incision and debridement of the right knee anterior soft tissues and prepatellar bursal area to include excision of compromised skin and subcutaneous tissue and superficial fascia with placement of wound VAC.
A: 0JBL0ZZ, excision of right upper leg subcutaneous tissue and fascia, open approach and 0S9C3ZX, drainage of right knee joint, percutaneous approach, diagnostic
Reference: ICD-10-PCS Official Guidelines for Coding and Reporting Section B3.5: Overlapping body layers