# Irrigation & debridement toe



## RebeccaMoney (May 9, 2019)

What CPT would you use for the following?  Doctor says 11044 but I can't justify any of the diagnosis due to LCD so Medicare won't pay.  Patient presented to us with toe pain. She has Multiple sclerosis.  Patient does not have pressure ulcers or wounds. 
PostOperative Diagnosis:Erosive Arthritis vs osteomyelitis
Procedure:.....A longitudinal incision placed over the dorsal aspect of the 2nd toe and dissection carried to the skin & subcutaneous tissue. The extensor tendons were then mobilized. Gross inspection revealed normal appearing synovial fluid from the DIP & PIP joint. The bone appeared firm and healthy. Moderate to severe arthritis of the DIP joint was appreciated. The PIP joint appeared to have mild arthritis changes. Everything appeared normal with no signs of infection. Samples were obtained. A swab was then obtained of the DIP and PIP phalanx  followed by tissue samples obtained for pathologic review & cultures.The site was then throughly irrigated .

Please help. Thank you,


----------



## Chelle-Lynn (May 9, 2019)

Assuming that the area is 20sq cm or less I would agree with the 11044 for the service performed.


----------



## RebeccaMoney (May 10, 2019)

Okay. Now I just need to figure out a diagnosis that Medicare will accept. Thank you for your input.


----------



## meghanhannus (May 14, 2019)

RebeccaMoney said:


> Okay. Now I just need to figure out a diagnosis that Medicare will accept. Thank you for your input.



Hi RebeccaMoney,

I do not see any debridement to the bone within the documentation you provided. I do see IP _(Distal and Proximal)_ joint exploration which is why I am thinking CPT 28024.

CPT 28024: The physician performs an arthrotomy of  interphalangeal joint  that includes exploration, drainage, or removal of any loose or foreign body. An incision is made over the joint to be exposed. The soft tissues are dissected away and the joint capsule is exposed and incised. The joint space is explored, any necrotic tissue is removed, and infection or [U]abnormal fluid is drained[/U]. If a foreign body is present (e.g., bullet, nail, gravel), it is exposed and removed. The wound is irrigated with antibiotic solution. The physician may leave the wound packed open with daily dressing changes to allow for drainage and secondary healing by granulation. If the incision is repaired, drain tubes may be inserted and the incision is closed in layers with sutures, staples, and/or Steri-strips.


----------



## RebeccaMoney (May 14, 2019)

meghanhannus said:


> Hi RebeccaMoney,
> 
> I do not see any debridement to the bone within the documentation you provided. I do see IP _(Distal and Proximal)_ joint exploration which is why I am thinking CPT 28024.
> 
> CPT 28024: The physician performs an arthrotomy of  interphalangeal joint  that includes exploration, drainage, or removal of any loose or foreign body. An incision is made over the joint to be exposed. The soft tissues are dissected away and the joint capsule is exposed and incised. The joint space is explored, any necrotic tissue is removed, and infection or [U]abnormal fluid is drained[/U]. If a foreign body is present (e.g., bullet, nail, gravel), it is exposed and removed. The wound is irrigated with antibiotic solution. The physician may leave the wound packed open with daily dressing changes to allow for drainage and secondary healing by granulation. If the incision is repaired, drain tubes may be inserted and the incision is closed in layers with sutures, staples, and/or Steri-strips.



That is a great idea. I like 28024.  I will talk to the doctor about that. Thank you so much.


----------

