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Tag Archives: Debridement

Nail debridement, nail avulsion, I&D paranychia

Posted on by
Hi Just wanted to get clarification on the procedures below and wondering if it’s coded correctly. Any thoughts?

PROCEDURE Each nail border was debrided of callused nail grooves, incurvated and ingrown areas, hypertrophied cuticle and mycotic and necrotic debris. Betadine solution was used to cleanse each nail plate for antiseptic reasons after debridement was performed.

OPERATION the affected areas were prepped in the usual sterile manner. The initial approach was made with an english nail splitter using that instrument to excise the nail border spicule along the full length of the nail from the tip to the eponychial attachment., Using a freer elevator and a medium hemostat the nail border was removed. The defect was curretted clean removing all necrotic and calloused nail groove and diseased cuticle.

The pus pocket paronychia abscess was incised and drained and any visible necrotic skin and tissue removed., The surgical wound was dressed using a Betadine pad drain, antiobiotic ointment, 4×4 digital cut, kling and stockinette.

CPT: 11721, 11730, 10060

Medical Billing and Coding Forum

Removal of fixation device with debridement

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I am getting and edit when coding 11043 (excisional debridement) with 20694. Message reads "You have coded 20694 with additional code(s) considered a component of this procedure." NCCI edits consider this separate reporting of codes that are components of the comprehensive procedure if billed for services provided to the same beneficiary by the same physician on the same day. These codes will be rebundled by your payer and payment will be based on code 20694 only." However, I believe the debridement took more time then the removal of the fixation device?

Diagnosis: Status post Charcot reconstruction with external fixation, Wound of right foot

Procedure performed: Right foot: #1 removal of external fixation #2 debridement of wound 2×3 (same foot) consisting of excisional debridement of skin, subtenons tissues portion of the fascia. #3) application of a well-padded short leg splint

The external fixator was removed in total. 2 half pins were removed as well as a trans-calcaneal pin and multiple smooth wires.

Extremity was then prepped, draped, and usual aseptic sterile manner. Patient has edema and venous insufficiency noted to the leg with verrucous hyperplasia nonhealing wound noted at approximate 2 x 3 cm. This was debrided consisted of excisional debridement of skin subtenons tissues portion of the fascia. Remenant of retained suture was removed. Then further debrided utilizing a curette. No purulence no clinical signs of infection were noted. At this time we pulse lavaged the wound out with 3 L normal saline. Please Xeroform over the wound followed by dry dressings and placed the patient in a well-padded posterior splint

Any help would be great! :)

Medical Billing and Coding Forum

Hand infection debridement

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Does anyone know what the appropriate CPT code would be for an irrigation and debridement of deep palmar infection of the hand?

OP report says: "First, I slowly cleaned the hand of chronic purulence that was stuck into the palm. Despite a preoperative scrub and sterilization, there was still caked on dead skin that took quite a bit of time to slowly clean her hand down to the level of the normal tissue. Once we got to that point, it was clear that there was infection deep in the palm at the level just distal to the carpal tunnel. There was a fair amount of purulence that was debrided at the level of the flexor tendon sheath and bursa throughout the palm. I copiously irrigated and debrided and eventually closed the wound with interrupted 4-0 nylon quite nicely."

Thanks!!!

Medical Billing and Coding Forum

is an arthroscopic biceps tenotomy inclusive to extensive debridement

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We were just told by our State Labor and Industries review department for prior authorization (Qualis) that per AAPC Coding guidelines, and arthroscopic biceps tenotomy (CPT 29999 compared to 23405) is inclusive to an arthroscopic debridement (29823), however, according to AAOS, these are not inclusive codes as well as looking at the NCCI guidelines Ch 4 section E subsection 7 –

7. Shoulder arthroscopy procedures include limited debridement (e.g., CPT code 29822) even if the limited debridement is performed in a different area of the same shoulder than the other procedure. With three exceptions, shoulder arthroscopy procedures include extensive debridement (e.g., CPT code 29823) even if the extensive debridement is performed in a different area of the same shoulder than the other procedure. CPT codes 29824 (arthroscopic claviculectomy including distal articular surface), 29827 (arthroscopic rotator cuff repair), and 29828 (biceps tenodesis) may be reported separately with CPT code 29823 if the extensive debridement is performed in a different area of the same shoulder.

There were 2 separate arthroscopic portals made one was posterior and then once tenotomy was complete scope was removed and an lateral acromial anterior portal was made.

Can someone tell me where this guidelines is… as I now have conflicting information.

Thank you in advance!!!!

Medical Billing and Coding Forum

Aortic valve debridement and replacement and bovine pericardial patch repair

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I am trying to verify the codes for the following:

Aortic valve debridement and replacement using 23 mm St Jude mechanical valve. (33405)
Aortic valve annulus abscess incision and drainage, debridement with bovine pericardial patch repair. (?)

I would appreciate any feedback on how to bill for the annulus I&D with bovine patch repair. The bovine patch was placed in the soft tissue defect of the commissure in between the right and left coronary sinus.

Thank you
Ruth Ann Grimes, CPC

Medical Billing and Coding Forum

Left neck wound debridement with removal of infected thyroplasty implant CPT CODE

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Can anyone out there help me with coding something. This patient had a Left neck wound debridement with removal of infected thyroplasty implant. I have never coded for this in the past and I a little stumped. The full procedure is "Left neck wound debridement with removal of infected thyroplasty implant, with adjacent muscle flap transfer using the sternocleidomastoid muscle into the defect left by removal of thyroplasty implant". I have the flap code as 15733. One person in the office said maybe we can use a Foreign Body code 20520, one person said 20670 but that code is for a superficial implant with buried wire, pin or rod…. Can anyone else help with this one. The only other code I can think of would be an unlisted code 31599. I would appreciate anyone’s input on this one thanks.

Medical Billing and Coding Forum

Exploration of perineum with coccygectomy and debridement of the devitalized tissue

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Hello. I’m hoping someone else migh have some input. I have gone round in circles in my head trying to code this out. I’ve never had to code a coccygectomy in any way, shape, or form LOL. I’m not so sure that 27080 fits appropriately in this case, but the dianosis is not a pressure ulcer either. I am so appreciative for ANY insight or thoughts. Thanks in advance.

Preoperative/Postoperative Diagnosis: Abscess of perineum with osteomyelitis of coccyx

Procedure: Exploration of perineum with coccygectomy and debridement of the devitalized tissue

Anesthesia: General

Procedure: Patient was taken to the OR. After adequate general anesthesia, the patietn was turned in a right lateral position. The area was prepped with DuraPrep and draped steriley. The patient had a fistulous tract, which was explored with a blunt clamp. The incision was carried down through subcutaneous tissues. There is a necrotic grey tissue with purulence noted. Culures were taken. This seems to encase the coccyx. The coccyx was removed with a Kocher clamp as well as a rongeur up to the level of the sacrum. The nectroic tissue was well excised. The depth of the wound was approximately 8 cm wiht a wound 10 cm long and 4 cm wide. The bone was exposed and excised as was deep tissues of the pelvis. The wound was inspected for hemostasis. Irrigation was utilized. Cautery was used to help with hemostasis. The wound was then treated with a wound vac, which was bridged to the left anterior thigh. The patient tolerated the procedure and was taken to the recovery room in stable condition.

Medical Billing and Coding Forum