# Excision and I&D



## BABS37 (Oct 18, 2012)

I just wanted to see what others would code the following as:

Surgery one 09/30
-midback lesion
-neck abscess

Following adequate anesthesia, both sites were prepped. An ellipse was formed around the midline neck lesion. This was excised sharply. A multilayer repair was performed with a total of 2.5 cm incision created. A single suture was placed. I went with 11423

Next, the posterior neck abscess was incised. This was a very large abscess. A transverse incision was made near the drainage site. Purulent secretions were present and irrigated. A blunt instrument was used to break down loculations. A significant amount of necrosis of the soft tissue of the neck was present. The abscess seemed to go very deep. It was packed with gauze dressings.  I went with 10060 

Surgery 10/01- Next day
-neck abscess/wound- deep tissue debridement of a right posterior neck abscess with wound washout and packing

The patient had an extensive neck wound from a MRSA abscess of the posterior neck. The patient underwent I & D yesterday with findings of substantial necrosis. He presents today for wound debridement. Following the adequate induction of anesthesia, the neck was prepped. The intrawound packing was removed. A moderate to extensive necrosis of the wound was present. The metzenbaum scissors were used to remove the necrotic material. Tissue planes of necrosis could be seen deep in the neck, and these were followed to the extent that they were present and necrotic. The wound was repacked. I couldn't decide between 11042-78 or 11000-78- I know we can't code for post-op wound care but he came back to the ER and the physician didn't docuement a lick of necrosis or MRSA from his report/surgery the day before so I assume this is a new finding/problem.
And I couldn't decide to do this as wound or necrosis. Thoughts?


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## FTessaBartels (Oct 22, 2012)

*I assume you ask about 10/1 surgery only*

I'm assuming you're asking about the 10/1 surgery only 


I'd use 11042-58  ... yes, FIFTY-EIGHTmodifier.  The 9/30 surgery clearly states that there was "a sgnificant amount of necrosis..."  so I would consider this a staged/related procedure.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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