# Excision of Suture Granuloma with Sinus



## christy.horrocks@lpnt.net (Aug 29, 2016)

I need help with the following Op Notes.  I cant figure out which codes to use.  Would I just use 10120/21.  This seems a little more in depth than that.

PROCEDURE:  Excision of the suture granuloma with the sinus.
ANESTHESIA:  General plus local regional block utilizing 20 mL of 0.5% Marcaine with epinephrine solution.
COMPLICATION:  None.
DETAILS OF THE PROCEDURE:  After the patient and the surgeon were mutually identified, the patient was brought to the operating room, placed on the operating table in supine position.  After adequate anesthesia was established, the patient's abdomen was prepped and draped in usual sterile fashion.  Then using elliptic incision, I excised the previous scar including the umbilicus, through the center of the umbilicus the patient had this chronic sinus draining purulence.  After excision was completed, I found 6 different sutures of what appeared to be Ethibond, which was used to repair the previous hernia.  They all had granulation tissue surrounding them.  Cultures were obtained in this location.  Wound was copiously irrigated with sterile saline solution and subsequently closed in layers.  I did not see any mesh material that supposedly was used for the previous hernia repair.  This mini laparotomy was then closed in layers using 0 PDS for muscle, fascia in interrupted fashion.  Monocryl was used for subcutaneous tissues, and skin was closed with 3-0 nylon interrupted sutures.  Sterile dressing was applied.  The patient in stable postoperative condition, was transferred to the recovery room.

Thanks in advance for any help.


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## danskangel313 (Sep 4, 2016)

IMO, there's a lot of information missing that seems like it should be included in the op note. For example, there is no depth of each layer reported, was there debridement done, and so on. Based on the narrative, I can't even decipher if the actual sutures were removed, so I don't think you can get by with a code for removal of foreign body. What I can pull out of this is the excision through the scar tissue and umbilicus, and some method to obtain "cultures" surrounding the granulation tissue in some particular, unknown area. 

I'd get clarification from the surgeon, unless I'm missing something...?


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