Assistance needed in coding this case for our ASC.
The physician wants to code as 11010 X 2 & 13160 X 2; however, those codes bundle leaving us with just 13160 as the procedure was performed in the same anatomical site.
My question is, would it be appropriate to code 13160 and 19340 LT for the extra work that went into the left side with the implant being removed, cleaned and replaced?
Pre/Post Op Dx: Bilateral incisional dehiscence of breast reconstruction, status post bilateral mastectomy and immediate reconstruction.
1. Debridement of bilateral breast
2. Secondary complex closure of wound dehiscence of bilateral breast
Indications and Findings:
Patient approximately one month status post bilateral mastectomy and immediate reconstruction using AlloDerm and a permanent implant. Today in followup, she was noted to have dehiscence of her incisions bilaterally. On the right, she remained with viable muscle at the base of her dehiscence; however, on the left, there was exposure of her underlying AlloDerm, and is now returned to the operating room for a secondary closure and attempted salvage.
On the right, the patient was noted to have incisional dehiscence; however, the pectoralis muscle remained viable at the base of the wound. There was no evidence of purulence. On the left, there was exposure of the underlying AlloDerm covering the implant. However, again, there was no evidence of purulence or significant infection. On the left, the wound was initially profusely irrigated with a Pulsavac irrigation system. The implant was then removed, and the entire wound again thoroughly irrigated, and the implant was soaked in Betadine for approximately 25 minutes. The implant was replaced and the wound secondarily approximated as described below.
Description: After anesthesia, the left breast wound was then cultured following which the anterior chest wall was prepped and draped in the usual sterile fashion. Nonviable tissue along the margins of both incisions were sharply debrided. Both wounds were then irrigated with the Pulsavac irrigation system using a betadine saline solution. On the right, the patient was noted to have viable pectoralis muscle at the base of the area of dehiscence; however, on the left, there was exposure of the acellular dermal matrix. The matrix was transected at the area of dehiscence and the implant removed. Again, there was noted to be no evidence of any purulence whatsoever within the pocket. The implant was completely submerged in a betadine solution following which the pocket on the left was again irrigated with a Pulsavac irrigation system. The entire operative field was then broken down and reprepped and draped in the usual sterile fashion. The pocket on the left was then again irrigated with 3 liters of a betadine/saline solution following which the implant was replaced within the pocket. The dehiscence was then approximated using interrupted sutures of 3-0 Vicryl to approximate the acellular dermal matrix in deep subcutaneous tissues. The wound was again irrigated with the Pulsavac irrigation system and the skin approximated using interrupted horizontal mattress sutures of 3-0 Prolene. On the right, the wound was reapproximated using interrupted horizontal mattress sutures of 2-0 Prolene. A sterile dressing consisting of xeroform gauze and Tegaderm was applied following which the patient was taken to the step-down unit in stable condition. All counts were correct. There were no complications.:confused::confused:
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