# ICD.10 code for draining Sinus?



## Orthocoderpgu (Oct 26, 2017)

I see this every once in a while and am now wondering what ICD.10 code other coders are using for this procedure.

In the case that I am working on now, the doc is dissecting down to a hematoma near the calcaneus and finds a draining sinus about 0.5cm square. 

What diagnosis code do you use for a draining sinus?


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## marty3073 (Oct 27, 2017)

*Draining sinus*

The "draining sinus" could be another term for the patient having bursitis. I hope this helps.

Marschand Martin


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## sxcoder1 (Nov 1, 2017)

I have a hard time with this also.  What do you use for excision of nonhealing sinus tract?  I've read some people use 13160? Or something like 13120?  Any input would be appreciated!


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## Orthocoderpgu (Nov 1, 2017)

*I was told*

For sinus tracks I was told to use 15002 -15005. I would be interested to see if other coders agree with this or not.


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## sxcoder1 (Nov 1, 2017)

I read that some people use 15002-15005 also, but it describes surgical preparation of a site for placement of  a graft so I was not sure.


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## AlanPechacek (Nov 2, 2017)

This query started as a diagnosis coding question (ICD-10), then morphed into a procedural question (CPT).  ICD-10 really doesn't use the term *"sinus,"* but kicks it over to *Fistula* instead.  Fistulas don't just "happen" by themselves, but arise from some other tissue disease/disorder.  In Orthopedics, this usually means bone, joint, bursa, muscle, tendon, etc., and is usually the result of a chronic process, which sooner or later becomes contaminated, then infected, and which finds its way to the surface through the subcutaneous tissue and skin, i.e. a chronic draining sinus/fistula.  From the standpoint of diagnosis coding, it depends on the deepest musculoskeletal "tissue" involved and/or the "site of origin," such as bone, joint, etc.  If it only involves the Skin and Subcutaneous Tissues, then that would be L98.8: Other Specified Disorders of Skin and Subcutaneous Tissue.  If it originates from bone, then there is probably some element of Chronic Osteomyelitis such that M86.4: Osteomyelitis, Chronic, with Draining Sinus (Fistula) would apply.  If it originates from within a joint, then M25.1: Joint Fistula would apply.  Another issue is whether the Fistula/Sinus is the result or complication of a previous wound, surgical or traumatic, slow or non-healing?  For a surgical wound, this would lead to T81.83: Persistent Post-procedural Fistula.  For a traumatic wound, there is T79.81: Slow or Non-healing Traumatic Wound (with Fistula/Sinus).  In other words, in order to code the "little picture," the fistula, you have to look at the "big picture," what happened before that resulted in this complication.
     As for the surgical treatment/procedure, again it goes back to the history of how it all evolved.  For a Surgical Wound with Dehiscence, then the 13160 would apply to repair of a deep and complex wound dehiscence, such as into a knee joint.  The other Repair/Closure of Wound Codes (Simple, Intermediate, and Complex) generally leads one to think that these apply to Acute Wounds, but there is nothing that I can see in the "Instructions" that would *Exclude* chronic wounds such as those resulting in a Fistula, so I guess these Repair codes could be used.  The 15002-5 codes refer to the exploration, debridement, etc. of a chronic wound situation for the "preparation" of the site for skin grafting, flap rotation, some other type of wound coverage, or Complex Closure/Repair.  These codes are for the wound preparation only, but wouldn't include the Repair Procedure code itself.  
     Obviously this is not a simple topic with a simple answer, but maybe this discussion will help you some.

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


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## sxcoder1 (Nov 3, 2017)

Thank you Dr. Pechacek for the information on a complicated topic.


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## Jbeck@karuk.us (Dec 19, 2018)

*Related question?*



AlanPechacek said:


> If it only involves the Skin and Subcutaneous Tissues, then that would be L98.8: Other Specified Disorders of Skin and Subcutaneous Tissue.  ...  Another issue is whether the Fistula/Sinus is the result or complication of a previous wound, surgical or traumatic, slow or non-healing?  For a surgical wound, this would lead to T81.83: Persistent Post-procedural Fistula.  For a traumatic wound, there is T79.81: Slow or Non-healing Traumatic Wound (with Fistula/Sinus).  In other words, in order to code the "little picture," the fistula, you have to look at the "big picture," what happened before that resulted in this complication.
> 
> Respectfully submitted, Alan Pechacek, M.D.
> icd10orthocoder.com



 Thank you so much for this!  I have a patient with 3 persistent fistulas in his thigh, "due to chronic injections on his own at home which were incorrectly administered" per provider's notation.  Would that be considered post-procedural, if patient gave himself the injection?  Or would I use T80.89: Other complications following infusion, transfusion and therapeutic injection?  Could this be considered a sequela?  I appreciate any light you can shed on this!

J. Beck, CMC


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