# Irrigation and debridement to bone foot



## Kestrelwa (Sep 19, 2019)

Hello,

What is the appropriate CPT for this surgery.  My provider uses 28005.  

DX:  Cellulitis and abscess of foot, large abscess on the plantar aspect of his foot with evident infection and erythema in light of Charcot neuropathy.

I then evaluated the wound. I sharply debrided nonviable skin, subcutaneous tissue, muscle, tendon and bone removing nonviable infected bone of the midfoot. 　This measured approximately 10 cm in length and 2 cm wide and 4 cm deep. I then irrigated 3 L of normal saline through the wound. I also a bottle of Aricept through the wound.

I then closed the wound with 0 PDS suture sterile dressing was placed. Patient was taken to the recovery room in a stable manner.

Thank you!


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## Orthocoderpgu (Sep 19, 2019)

Can you post the entire redacted note? If not, did the surgeon open this area up before debriding or was the wound already open? 28005 is good if the doc had to make an incision and cut down to the bone, but this note makes me think the would was already open which would change the coding entirely. 28005 is for removal of bone cortex, other codes (saucerization) may be more appropriate of more bone is removed.


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## Kestrelwa (Sep 20, 2019)

Orthocoderpgu said:


> Can you post the entire redacted note? If not, did the surgeon open this area up before debriding or was the wound already open? 28005 is good if the doc had to make an incision and cut down to the bone, but this note makes me think the would was already open which would change the coding entirely. 28005 is for removal of bone cortex, other codes (saucerization) may be more appropriate of more bone is removed.



Hello, 

Here is the entire note:


Pre-op Diagnosis: Cellulitis and abscess of foot [L03.119, L02.619]Open wound of plantar aspect of foot, right, initial encounter [S91.301A] ,

Post-op Diagnosis: 　Same

Procedure:　Irrigation and debridement to bone right foot

Estimated Blood Loss:　None

Complications:　None

Specimen:　A deep culture was obtained of the right foot


Technique/Procedure Description:　The patient was brought to the operative room. 　IV antibiotics had been administered. 　Gen. anesthesia was administered.

A well-padded tourniquet was placed around the right calf. 　The right foot was prepped and draped in a sterile manner.

The tourniquet was inflated and an incision was made on the plantar surface of the foot to excise the sinus tract of the abscess that extended down to the bone of the midfoot. 　Dissection was carried through the skin and soft tissue. 　The sinus tract was excised. 　A deep culture was obtained.

 I then evaluated the wound. 　I sharply debrided nonviable skin, subcutaneous tissue, muscle, tendon and bone removing nonviable infected bone of the midfoot. 　This measured approximately 10 cm in length and 2 cm wide and 4 cm deep. 　I then irrigated 3 L of normal saline through the wound. 　I also a bottle of Aricept through the wound.

I then closed the wound with 0 PDS suture sterile dressing was placed. 　Patient was taken to the recovery room in a stable manner.
​


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## Orthocoderpgu (Sep 23, 2019)

Because the surgeon had to cut down to bone due to the draining sinus I would use 28005. If it were not for that, I would have used 11044. Any questions let me know.


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## Kestrelwa (Sep 26, 2019)

Orthocoderpgu said:


> Because the surgeon had to cut down to bone due to the draining sinus I would use 28005. If it were not for that, I would have used 11044. Any questions let me know.


Thank you taking a look at this. I appreciate the feedback!  Have a great day.


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