Claim facts:
- The hospital coder assigned a procedure code of 86.22.
- In the medical record, the physician writes ?debridement was performed.?
- Coding Clinic 1991Q3 states: "Unless the attending physician documents in the medical record
that an excisional debridement was performed (definite cutting away of tissue, not the minor
scissors removal of loose fragments), debridement of the skin should be coded to 86.26, non
excisional debridement of skin ? Any debridement of the skin that does not meet the criteria
noted above or is described in the medical record as debridement and no other information is
available should be coded as 82.26." - The RAC determined that the claim was INCORRECTLY CODED and issued a repayment
request letter for the difference between the payment amount for the incorrectly correctly coded
procedure and the payment amount for the correctly coded procedure.
Corrective actions:
- Hospitals can be more careful when submitting claims for excisional debridement.
- Medicare claims processing contractors can remind hospitals about the importance of following the coding clinic guidelines when submitting claims for excisional debridement.
Read more about the RAC program and the evaluation report. Read a list of the services that received the most in overpayments.
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