# Irrigation and debridement of post wound



## TamaraM

HELP! I AM TRYING TO CODE AND IRRIGATION AND DEBRIDEMENT OF POST WOUNDS/AMPUTATION. THE WOUND CARE CODES WILL NOT WORK BC PTS ARE UNDER ANESTHESIA. I HAVE RUN INTO TO 2 OF THESE CASES. WOULD CPT CODE 11004 WORK??

HERE IS A SCRUBBED VERSION OF WHAT I AM CODING:
PT who has had a debridement and attempted wound closure in the past. Due to his continued drainage and wound problems, irrigation and debridement and possible further proximal osteotomy of the metatarsals in order to get the wound closed.
i began extensively debriding the necrotic and gangrenous tissue on the right forefoot. then subperiosteally exposed the trans metatarsals and took this back with a rongeur, far enough to where I had viable and healthy bone and bleeding tissue. This was essentially almost to the level of the tarsal metatarsal joint area. After I debrided sufficient tissue, I then worked on three additional wounds that were just on the periphery to the main wound. This was debrided extensively. I then washed 6000 cc of Gentamicin impregnated saline. This was all done after deep wound cultures were obtained.
I then was able to perform a wound closure using 2-0 Nylon suture in a vertical mattress fashion, closing all wounds except for the three peripheral wounds. A sterile saline dressing was applied to these wounds and a compressive dressing was applied to the remaining forefoot.

any suggestions????


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## smcbroom

looks like a 11044 to me.


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## Bella Cullen

tamara818 said:


> HELP! I AM TRYING TO CODE AND IRRIGATION AND DEBRIDEMENT OF POST WOUNDS/AMPUTATION. THE WOUND CARE CODES WILL NOT WORK BC PTS ARE UNDER ANESTHESIA. I HAVE RUN INTO TO 2 OF THESE CASES. WOULD CPT CODE 11004 WORK??
> 
> HERE IS A SCRUBBED VERSION OF WHAT I AM CODING:
> PT who has had a debridement and attempted wound closure in the past. Due to his continued drainage and wound problems, irrigation and debridement and possible further proximal osteotomy of the metatarsals in order to get the wound closed.
> i began extensively debriding the necrotic and gangrenous tissue on the right forefoot. then subperiosteally exposed the trans metatarsals and took this back with a rongeur, far enough to where I had viable and healthy bone and bleeding tissue. This was essentially almost to the level of the tarsal metatarsal joint area. After I debrided sufficient tissue, I then worked on three additional wounds that were just on the periphery to the main wound. This was debrided extensively. I then washed 6000 cc of Gentamicin impregnated saline. This was all done after deep wound cultures were obtained.
> I then was able to perform a wound closure using 2-0 Nylon suture in a vertical mattress fashion, closing all wounds except for the three peripheral wounds. A sterile saline dressing was applied to these wounds and a compressive dressing was applied to the remaining forefoot.
> 
> any suggestions????



You cannot use 11004 because that is for external genitalia and perineum.  
I would use 28005 
In the coders desk reference the description says:
The physician incises the bone cortex of infected bone in the foot to treat an abscess or osteomyelitis. The physician makes an incision over the affected area. Dissection is carried thrrough the soft tissues to expose the bone. The periosteum is split and reflected from the bone overlying the infected area. A curette may be used to scrape away the abscess or infected portion to healthy bony tissue or drill holes may be made through the cortex into the medullary canal in a window outline around the infected or abscessed bone. The area is drained and debrided of infected bony and soft tissue. The physician irrigates the are with antibiotic solution, the periosteum is closed over the bone, and the soft tissues are sutured closed, or the wound is packed and left open, allowing the area to drain.


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## TamaraM

Thanks i knew the 11004 (AFTER I POSTED IT AND ACTUALLY READ WHAT IT SAID) AND WOUND CARE CODE wouldn't work. I HAD SEEN THE 28005 BUT WASN'T REALLY SURE WHAT IT CONSISTED OF, BUT AFTER I READ YOUR DESCRIPTION I THINK ITS THE ONE!! THANKS SO MUCH!!


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## Bella Cullen

Your welcome!!!!


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