# Need help coding:  Stump revision or just I&D?



## primrose1 (Jun 13, 2018)

I'll try to post a scrubbed up op note.  I'm not sure if I should code this with the debridement codes because of the abscesses/ulcers or is this considered a stump revision?  I was going to code it a revision but the surgeon did 11044 & 11047.  Any help which way I should go?


Patient's right lower extremity was marked in the preop period.  Patient was then brought back to the OR where she was given spinal followed by general anesthesia. A tourniquet was placed on the patient's right thigh.  Patient's right lower extremity was prepped and draped in normal sterile fashion.  A timeout was taken and was agreed upon by Lillie had the correct site and procedure and correct patient.  Next a scalpel blade was used to make a transverse incision following the previous scar at the stump of the AKA.  At this point the sinus tract of the abscess at the skin level was ellipsed out.  Next the soft tissue abscess approximately 2 cm in diameter was excised from the subcutaneous layer at the apex of the  stump.  Next a longitudinal incision approximately 3 fingerbreadths in length were his made over the lateral aspect of the thigh over top of a firm area which represented a 2nd soft tissue abscess.  The 2nd abscess approximately 3 cm in diameter was excised using electrocautery from the subcutaneous layer.  Next using that lateral incision blunt  finger dissection was used to free the cavity  superficial to the fascia over the lateral aspect of the thigh.  Deep cultures were taken at the distal incision.  Next at the distal aspect of the stump the fascia was incised down to bone at the distal femur.  No gross purulence or soft bone was noted.  The content of the intramedullary canal was evacuated at the distal 1 cm.  Next large Roger was used to remove approximately 2-3 cm off the distal aspect of the femur circumferentially.  Next the distal and lateral wounds were irrigated out with pulse lavage approximately 3 L of saline.  Next the subcutaneous layer was reapproximated using PDS in simple stitch fashion.  Skin was reapproximated using 2-0 nylon in simple stitch fashion.  Prior to  wound closure 2 Hemovac drains were placed.  The 1st Hemovac was placed adjacent to the distal femur exiting  adjacent to the distal incision.  The 2nd Hemovac drain was placed along the lateral aspect of the thigh superficial to the fascia.  Next the tourniquet was deflated and patient recovered from anesthesia.  Then transferred to PACU postoperatively in stable condition.


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## fish4codes (Jun 14, 2018)

The CPT lay description for stump revision "27596" reads:  

After the stump has granulated or healed by scar, the physician performs secondary closure or scar revision. This procedure is usually performed two to three weeks or more after the initial open amputation was completed. Additional bone is sectioned, usually at a more proximal or higher level. Skin flaps are fashioned and pulled over the stump and closed with nonabsorbable sutures. A temporary drain or suction tubes are used as well.

Your surgeon clearly states "large Roger was used to remove approximately 2-3 cm off the distal aspect of the femur circumferentially"... 

Now whether other codes can be used, this is out of my comfort zone - I'm hands - but it appears the 27596 to be appropriate...

Would like to hear thoughts from others ...


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