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Clinicians will soon be able to better identify and track deep pressure-induced tissue damage in their patients for surveillance and quality improvement purposes. Several new ICD-10-CM codes under category L89 Pressure ulcer clear up the confusion that was created between the diagnosis code set and promulgated clinical literature after the National Pressure Ulcer Advisory Panel […]
The post Coding Deep Pressure-Induced Tissue Damage in FY2020 appeared first on AAPC Knowledge Center.
Just wanted a second opinion.
"A dorsal curviliner incision was made on the dorsum of the long finger centering over the soft tissue masses. The incision was carried thru the skin and subcutaneous tissue. Hemostasis was achieved with bipolar electrocautery. The skin was gently elevated off the underlying soft tissue mass with a #15 blade knife. The masses were dissected from the surrounding soft tissue with care taken to protect the neurovascular structures and the extensor tendon. Both masses were excised and sent for microscopic pathology. The extensor tendon remains intact."
Urologist does an open debridement of necrotic tissue found on the exterior of the bladder and the peritoneal reflection. Bladder was irrigated and small clots cleared. No leaks or masses are noted, so he elects not to open the bladder. No cystoscopy is performed. Debridement is performed on the infected, necrotic area of the right lateral bladder wall and the peritoneal reflection. Original source and etiology are unclear. All necrotic tissue was debrided, the area washed out, two drains placed.
Do I go with debridement codes? The only thing I’ve come close to that doesn’t involve cystoscopy/the interior of the bladder is 11043.
Any help or thoughts would be appreciated.
Tissue adhesive, or cyanoacrylate, is like “Super Glue” for the skin. Commonly known as Dermabond® (which is a brand of tissue adhesive sold by Ethicon™), cyanoacrylate is a liquid that may be used to close wounds, either in place of or in addition to other closures methods such as sutures or staples. When used alone, […]
The post Tissue Adhesive Wound Closure Coding appeared first on AAPC Knowledge Center.
Pre-op Diagnosis:
history of left breast cancer, acquired absence bilateral breasts
Postop Diagnosis:
same
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Procedure:
Bilateral – REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS
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Implant:
Implant Name Type Inv. Item Serial No. Manufacturer Lot No. LRB No. Used
800ML BREAST IMPLANT Breast Implants *
800ML BREAST IMPLNT Breast Implants
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Condition: stable
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Indications for Surgery:s/p bilateral mastectomies with tissues expander reconstruction 3/23 for left breast cancer. *She completed her expansion at 750 cc and is happy with her size.*Plan for second stage breast reconstruction with removal of tissue expanders and placement of permanent round silicone implants.**Risks of infection, scarring, asymmetry, wound healing issues, hematoma, seroma, contracture and implant loss discussed and consent obtained.
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Procedure: in the preoperative holding area and appropriately marked. She was then brought back to the operating room and placed supine on the operating room table. SCDs were placed on bilateral lower extremities. Her arms were outstretched on padded foam arm rests and abducted to less than 90 degrees at the shoulder. . She underwent general anesthesia. A pec 1/2 block with exparel was performed. She was prepped and draped in the usual sterile fashion. Attention was first turned to the left breast.. *I entered through the old medial IMF*mastectomy incision. I then raised the mastectomy skin off from the implant capsule approximately 1 cm superiorly and inferiorly. I then made a capsulotomy. The tissue expander was intentionally ruptured and removed.* Under direct visualization with a lighted breast retractor *capsulotomies were performed superiorly and medially. The capsule was also scored anteriorly. *The lateral IMF was recreated with several figure of 8 2-0 maxon sutures after scoring the lateral breast capsule. This was done to move the footprint of the pocket 1-2 cm medially. An 800 smooth round gel sizer was placed which filled the skin envelope. *Antibiotic irrigation was used to irrigated the cavity which consisted of 500 cc NS and 1 gram ancef, 80 milligrams gentamycin, and 50,000 units of bacitracin. Electrocautery was used for hemostasis. *Following this I changed my gloves and a smooth round high profile gel 800 cc implant was placed. The capsule and skin were then closed with interuppted 3-0 polysorb sutures. Then a running 4-0 biosyn subcuticular suture was used. *
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Attention was then returned to the right side. *The same procedure was performed. *Less capsule release was performed, and no capsulorraphy laterally was needed. Dermabond prineo was placed over the incisions. 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.
thanks
There has been ongoing debate about how to code complex repairs versus tissue transfers and rearrangements. Correct coding requires an understanding of the two surgical approaches. In the latest update to the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services, the Centers for Medicare & Medicaid Services (CMS) clarifies its definition of these […]
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NCCI shows indicator 1:
20071001 * 1 Standards of medical / surgical practice