Operation: Excisional debridement of bilateral lower extremity and right foot burn wounds.
Technique: All of the burn eschar was cut away sharply with scissors and erectile tight debridement was carried out getting rid of all the chronic burn tissue. The area of the deepest burn appeared to be in the foot and the lateral portion of the knee. All of these burns went down into the subcutaneous tissues. Once all of the burn tissue was excised, the areas were scrubbed with normal saline and scrub brush. Attention was turned to the left leg. The wounds were once again debrided sharply with scissors excising all of the burn as followed by the curettage and brushing with saline. All areas were placed in Xeroform gauze 4×4’s and Curlex.
Sizes of Burns 3rd Degree
1) left thigh 5×3 cm
2) left thigh 4×3 cm
3) left knee 10×5 cm
4) right thigh 7×5 cm
5) right knee 18 x14
6) right foot 10×7 cm
The Dr wants to bill 15002, 15003 x3 15004 but his dx T24.311A, T24.312A, T24.322A, T24.321A, T24.331A, T24.332A shows under LCD as not medically necessary.
I asked him to look at codes 16020, 16025, 16030 and he stated that those were bedside procedures. I am also wondering if I could use 97597 or 97598 for the debridement.
He then took the patient back to surgery about 3 days later;
Operation:
1) split thickness skin graft to left thigh 4×3 cm
2) split thickness skin graft to left knee 10×5 cm
3) debridement subcu tissues with primary closure of burn wound left thigh 5×3 cm
4) split thickness skin graft to right thigh 7×5 cm
5) split thickness skin graft to right knee 18 x14 cm
6) debridement of right foot to and including fascia 10×7 with placement of wound vac
The ties were performed of all the areas that had previously been debrided and excised. There was good granulation tissue in the bases of the wounds except for the right foot. Sharp debridement with scissors was carried out of the right foot wound and skin subcu tissues and fascia were actually excised to get below the non-viable tissue. This left some tendon exposed. This area was not suitable for graft placement at this time it was decided that wound vac be placed here. Attention was then turned to her right upper thigh where a dermatone was used to take 2 grafts at 18/1000 of an inch thick. The grafts were meshed 1/2-2 and laid over the above mentioned wounds. It was stapled into place. The left medial thigh wound was debrided down to the viable subcu tissue and then skin was closed primarily with staples. The wound vac was then placed on the right foot. and xeroform 4×4 Kerlix Ace dressings were placed over the extremity wounds.
The Dr is wanting to bill 15002, 15003 x 3, 15004, 15100, 15101 x3
So far, I have come up with 15120 and 97605 and wondering about using the 97597 or 97598 for debridement