August 2004: Debridement Tips

Michael Setzen, MD, FARS

Document Proper use of 31237

Dictate or write up a brief operative report.

  1. Include discussion of risks, benefits, alternatives.
  2. Anesthesia used-local or general
  3. Tissue or debris removed
  4. Site from which tissue removed
  5. Instruments used
  6. Bleeding if any
  7. Patient tolerance.

Documentation should be detailed, with detailed description as follows:

Anesthesia
Local, general or none used. If topical how was it applied and if so what was used. If injection, what was used and how much.

Location
Mention in detail any tissue removed from areas adjacent to skull base, lamina papyracea, frontal recess, maxillary, ethmoid or sphenoid sinus, middle or inferior turbinate or septum.

Tissue removed
Bone, polyps, polpoid tissue, mucus, crusts , escar and from where.

Instrumentation used
Polypectomy forceps, suction, blunt probes, curettes. Any irrigation or insertion of antibiotics or clotting agents to be mentioned.

Bleeding
If excessive make note of this and document the need for packing or cauterization.

Time
Mention, especially if a long time was used.


It is important that appropriate documentation be utilized since CMS is looking closely at this code for:

  1. Inappropriate utilization
  2. Increased Utilization.

With respect to inappropriate utilization one should only use this as suggested above. If an endoscopic examination is being done without genuine removal of debris or tissue then CPT code 31231 should be used.

Of interest the rate of debridement is lower than expected (less than 1.5 performed per ethmoidectomy). In spite of this the rate of debridement has increased each year since 1998.

Reason for increased rate of debridement:

  1. More surgeons performing post op care due to
    1. Poor results without debridement
    2. Improved training
  2. More surgeons coding for work performed.


Endoscopic Debridement:Medicare Utilization
   
 

Ethmoidectomies Debridements
Year Number of Procedures Number of 31237s Number per Year
1998 24,342 20,322 0.83
1999 24,977 26,014 1.04
2000 24,800 30,627 1.23
2001 25,000 36,674 1.46 



The ARS continues to work hard evaluating CPT Coding issues and ensuring appropriate and reasonable reimbursement and will recommend guidelines.

Documentation. Documentation. Documentation.


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Revised 8/2004
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