# Please help with cpt - about the codes



## ggparker14 (Mar 8, 2011)

physician wants a 28002 and 28192. Just not sure about the codes. Any help is appreciated.

procedure: incision and drainage right plantar foot abscess with the irrigation and debridement of wound. Puncture would was then required extension of the puncture area and incision measuring approximately 4 cm for adequate irrigation and debridement. Wound was packed open.

An oblique incision was fashioned over the puncture wound extending it distally to the area between the first and second metatarsals. Care was taken to protect surrounding neurovascular structures. The common digital nerve to the area between the second and third toes was identified, it was noted to be somewhat contused. The common digital nerve between the first and second toes were intact but there was also some area of contusion in between the mid to metatarsals. It appeared there was purulent material after incison of the skin and this was sent for culture. I followed the trail the tract of the nail. There were a few pieces of metal that were removed. The wound was irrigated with antibiotic solution. The common plantar digital nerve was intact betwen the first and second toes but there was some irritation over both the medial and lateral aspects of the flexor tendon sheath with underlying infection. The wound and the puncture tract was thoroughly irrigated with antibiotic solution. After the skin cultures were taken prior to the irrigation. The wound was packed open with half inch lodoform gauze. A bulky sterile dressing was applied.


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## btadlock1 (Mar 8, 2011)

I'm just guessing here, but I don't think it qualifies for 2 codes. The pair you mentioned has an NCCI edit of 1, so they'd have to be separate procedures to be billed together - it sounds like your doctor only did one actual procedure, so I'd stick to finding the code for the furthest extent of the procedure. I'm not_* sure *_about the codes, but it seems to me like the procedure being described fits with either 20103 or 10121; I'm not sure which one, though (if either) - I can't decide if this counts as "penetrating trauma", since the examples given are gunshot, stabbing, etc. - it seems like getting stabbed in the foot with a giant nail should be considered penetrating trauma, but I've been wrong before!  I hope something I just said was useful to you!


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## ggparker14 (Mar 8, 2011)

I appreciate your help.  I was looking at 20103 also and I too, was wondering if this would qualify as a penetrating wound.  I would like some other opinions if possible.


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