New to General Surgery (Neurosurgery/Orthopedic coder here) HELP!
How would you code this? I’m really struggling with these wide excisions. The physician calls them Fascectomies. Excision of Fascia. What do I do with that?
I’ve had surgeries that have been 40 x 40. I’ve been coding the debridement codes but, sometimes they go way over the MUE’s for one day.
There has to be better codes for huge debridements.
This particular patient had a skin graft and debridement prior to this surgery.

Here is the operative report:

PREOPERATIVE DIAGNOSIS
Previous severe infection with excision debridement, flap closure
as well as skin graft 20 x 10 cm.
POSTOP DIAGNOSIS
Previous severe infection with excision debridement, flap closure
as well as skin graft 20 x 10 cm.
ANESTHESIA
General.
PROCEDURE
Removal of dressing of the whole upper extremity as well right
thigh, removal of staples of the skin graft, 10 x 20 cm of the
forearm, debridement of the skin graft from all the edges as well
necrotic areas in the center. The graft took at least 95% for the
multiple sides that we grafted; as well the flap closure all of
them look healed with no infection. Then after the staples were
removed from all the graft as well the graft debrided and cleaned,
the hand and whatever the rest of the arm was cleaned good.
Neosporin and Xeroform was wrapped around the hand, thumb, arm,
forearm, elbow and arm followed by multiple layers of Kerlix with
Hypafix tape. No bleeding during the procedure. Then, the donor
site was removed as well and covered again with Xeroform and ABDs
as well fluffs, taped with Hypafix tape.
During procedure, the patient’s vital signs stable, was no
bleeding. Dressing have to stay until Monday to be removed again
and see if the patient can keep his wounds opened, depending on
the finding at that time. He is going to be discharged home
today.