# I & D -v- repair and debridement



## rmickalich (Nov 10, 2010)

Below is the procedure in detail and the physician is completing an I & D, but I am confused as to why I would code out an I & D instead of the repair?  

septic arthritis, right finger, metarcarpophalangeal joint
wound-hand laceration over the dorsum 
procedure: Incision and draingage

Findings: thin pus in the areolar space deep to the subcutaneous tissue.  The peritenon was moderately inflamed.  

There was rent in the proximal aspect of the joint capsule just radial to the extensor tendon.  Inflamed synovium and peritenon were debrided.  The wound was irrigated with normal saline  The extensor retinaculum was closed with interrupted 5-0 nylon suture.  A 5-millimeter pediatric feeding tube was left in the joint exiting through the skin proximal to the wound.  The skin edges were debrided at the traumatic wound and skin was closed primarily.

The traumatic wound was extended proximally and distally and blunt dissection deep to the skin revealed the infection.  Debridement proceeded and the wound was copiously irrigated with gravity, normal saline lavage.  A secondary debridement was accomplished.  Irrigation was again performed.  The joint was repetitively flexed and extended to allow irrigating into the volar aspect.  

The wound was drained.  The drain was placed.  The extensor retinaculum was repaired with 5-0 nylon.  A sterile dressing was applied along with a splint.


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## kmhall (Nov 11, 2010)

In CPT under the description of Repair (Closure), #4 reads, "Involvement of nerves, blood vessels and tendons: Report under appropriate system (Nervous, Cardiovascular, Musculoskeletal)..."  "The repair of these associated wounds is included in the primary procedure unless it qualifies as a complex wound, in which case modifier 51 applies...."  "If the wound requires enlargement, extension of dissection (to determine penetration), debridement..., not requiring thoracotomy or laparotomy, use codes 20100-20103 as appropriate."

Keywords
*Involves a tendon
Repair is included
Requires enlargement*

I hope this helps.


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## preserene (Nov 15, 2010)

Yes, you directed it correctly. In so saying, the debridement  and the I & D  are all included into this code 20103 . if it involved time more and work than the usual designated for that procedure, you can append Mod 22 if aporopriate .


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