# Incision & drainage vs arthrotomy



## LIVE2CODE (Jul 17, 2017)

My doctor made 6CM incision over the dorsal wrist dissected down open retinaculum to expose EDC & EPL tendons.He opened the wrist capsule and noted immediate release of purulent drainage sent to pathology. He then irrigated wound, split the capsule,irrigated the wrist cauterized bleeders and placed a Penrose drain in the radiocarpal joint. Would 25040 or 25101 be more appropriate than 25028? Any help would be appreciated.


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## Orthocoderpgu (Jul 18, 2017)

I&D is used when a joint has not been entered. Since your doc opened the joint capsule, I would not use the I&D since a capsulotomy is more appropriate.


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## AlanPechacek (Jul 19, 2017)

Based on the Operative Report as described, your surgeon did an Arthrotomy of the Radoiocarpal Joint for Septic Arthritis.  The best code for this would be 25040.  Most Orthopedic Surgeons would call this an "Incision, Drainage, and Irrigation of the Wrist Joint (for Infection)."  The 25028 code would be for an I&D of an extra-articular infection/abscess in the wrist area, but does not include entering the joint.  The 25100 code leads away from an infectious/septic wrist joint disorder to other possibilities.  The semantics of the descriptors is very confusing.

Hope this helps.

Respectfully submitted, Alan Pechacek, M.D.
icd10orthocoder.com


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