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Tag Archives: abscess

Please help! – Breast–IRRIGATION & DEBRIDEMENT BREAST WOUND / ABSCESS

Posted on by
Hello, which debridement code should I use along with implant removal code?

Operative Procedure: A 3.5 cm diameter circle at her mastectomy scar, and a 2.5 cm diameter circle superiorly where her tissue expander port site was previously located. Her implant is grossly visible at both of these locations. There is a thin intervening skin bridge connecting these 2 locations. With her consent a photo was taken in preoperative holding area and scanned into media prior to surgery. The skin bridge is clearly not viable and it is incised. The implant is removed and sent to pathology for gross examination. The implant pocket is then copiously irrigated with 3 L of pulse lavage saline. There is an inflammatory rind evident in the pocket. However there is no gross purulence. At the level of the prepectoral plane under direct visualization using cautery the skin flaps are elevated circumferentially. Using a 15 blade the skin edges were then debrided to remove the circular skin defects which leads to a vertical defect measuring 11 cm her left chest wall. The skin edges do bleed with this tissue removed. The mastectomy skin is sent to pathology for examination. 30 cc of quarter percent Marcaine with 1:100,000 epinephrine is injected for local anesthetic and hemostasis. With the wide undermining I am able to close the skin flaps with only minimal tension. Hemostasis is achieved using cautery. Saline was used for additional irrigation. A 10 French round JP drain is placed within the pocket. 3-0 Vicryl sutures were used to reapproximate the dermis. 4-0 Monocryl horizontal mattress sutures were used to loosely reapproximate the skin edges. A 13 cm Prevena incisional wound VAC is placed over the incision. A drain sponges placed around the drain site. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
*

thank you :)

Medical Billing and Coding Forum

Abdominal Wall Abscess- Exploration of abdominal wall with debridement and drainage

Posted on by
Just trying to feel a bit more secure in coding this one. Any thoughts are appreciated. Thanks in advance!!

PREOPERATIVE DIAGNOSIS:
Abdominal wall abscess.
POSTOPERATIVE DIAGNOSIS:
Abdominal wall abscess involving urethral sling.

PROCEDURE PERFORMED:
Exploration of abdominal wall with debridement and drainage.

DESCRIPTION OF PROCEDURE:
The patient was taken to the OR. After induction of adequate general anesthesia, the patient was prepped with Betadine and draped sterilely. The abscess was slightly to the right of midline extending from across the symphysis towards the right mons and labia. The incision was made to the right of midline, carried down through subcutaneous tissue. Upon entering the cavity, foul-smelling frothy fluid exuded. Cultures for anaerobic and anaerobic were taken. There was necrotic tissue underneath. Extensive debridement was performed tunneling to the left of midline along the pubic ramus was noted and then significantly towards the labia and then also towards the right anterior superior iliac spine. The area was well debrided completely open with no residual necrotic tissue appreciated. In the base of the wound, the sling was noted. The thinned end of polypropylene was easily detached on the left side, but as well secured to the right of midline and tunneling down towards the introitus in the urethra. It was still well attached. Decision was not to more aggressively pull on this but to tag it with 0 silk suture and __________ that proper debridement of all areas were performed. The debridement extended from the skin through all subcutaneous tissue down to the pubic ramus and symphysis. The fascia was exposed. The area of debridement measured approximately 15 cm x 12 cm. The
patient’s wound was packed with Kerlix and a dry sterile dressing. She was taken to recovery room in stable condition.

Medical Billing and Coding Forum

Colectomy with abscess drainage 49020-59 Bundled?

Posted on by
So, doctors are on a 49020-59 roll and want it on all colectomy procedures that mention peritonitis, such as 44143 (Hartman’s). I specifically asked someone at a seminar this scenario and was told no:

If the doctor opens a patient and finds an abscess on one portion of intestine (say transverse), drains it, and then performs a Hartman’s (not involving the transverse), can we bill a 49020-59 with it?

If the doctor opens a patient and finds pus and fecal matter in the abdomen due to perforation, drains it, and then performs a Hartman’s, can we bill 49020-59?

I know my opinion/thoughts on it but don’t want to sway anyone with them.

Medical Billing and Coding Forum

Abscess

Posted on by
My general question is, if a patient comes in with an abscess, the surgeon goes in and finds pus subcutaneously but also disects down the fascia just to make sure its not at that level as well, do you code the level of the fascia because it was exposed or only subcutaneously because thats where the work was done?

Sorry if this is in the wrong section. I asked someone pretty high up in my organization days ago, and she still hasn’t responded and I wouldn’t think it would take days to get a response on this.

Medical Billing and Coding Forum

Repeat washout and placement of drain for complex perineal/scrotal abscess

Posted on by
Hi all,

I’m trying to determine if this is correct. The patient underwent 46040 a few days ago and due to the complexity of the abscess, they brought the patient back to the OR to perform washout and placement of a JP drain to facilitate healing.

Would I still report 11004 if he’s not actually documenting any debridement?? How do you capture revenue for bringing the patient back to the OR if he’s basically just performing wound care under anesthesia?

Op report states:
we prepped and draped the area and after our final verification we proceeded. We washed out the wound copiously with saline. We then again identified the tracking down towards the perineum close to the perianal area.
Due to the complexity of the wound and tracking, as well as difficulty with packing, I elected to leave a Penrose drain by making a small counterincision slightly into the perianal area. I made a small counterincision a couple of inches away from the already existing scrotal wound. I passed a one-inch Penrose through the deepest part of the already existing abscess cavity and once I did that we secured hemostasis. We washed out the wound further. I secured the Penrose on itself so it was looped and then placed some one-inch packing into both wounds. There were no other complications. We placed a dry gauze as well as a scrotal support and the patient tolerated the procedure well. He was taken out of lithotomy and extubated

Medical Billing and Coding Forum

Abscess Coding Question

Posted on by
So, I’m doing the AAPC CPC Study Guide and Ch 5 has a question that reads "A 4-year-old presents with an upper arm abscess in the subcutaneous tissue. An I&D is performed. Pus is expressed and dry gauze dressing is applied. The procedure is coded as:
A. 10060
B. 10061
C. 23930
D. 10180"

They say that the correct answer is A, going Incision and Drainage/Abscess/Skin.
Why would it not be C, though, for Upper Arm?

Any help is greatly appreciated.

Medical Billing and Coding Forum

Still an Abscess, or Non-Healing Operative Wound?

Posted on by
Wound care coding question! I’ve been working on educating the physicians I work with on ICD10 since it became effective. There has been a constant ongoing debate between the three of them as to what diagnosis to use in a particular situation involving abcesses. When an abscess is incised and drained, and they are referred to us for treatment because the wound will not heal, one physician wants to now call the abscess a nonhealing operative wound because they state they’ve had surgery, while the other two say it’s still an abscess.I have posted the question in social media coder groups. When it was suggested that we go with the diagnosis on the referral, I have suggested that to the doctors and, unfortunately, the referrals basically state "wound care", "wound left foot" or "wound abdomen" – they dont’ specify what type of wound. I need help to settle this matter once and for all. Any documentation that I can provide them is greatly appreciated, as I have researched and cannot find anything definitive.

Medical Billing and Coding Forum