# Debridement 11004 vs 11043, 11046



## surgerycoder (Aug 14, 2014)

Question about these four cases. (Same patient, four different dates of service within 10 days)
Below is the operative reports for all 4 cases.  
Doctor is questioning use of:
11004 vs 11043, 11046x49 on first case.
11001 vs 11004 or 11043, 11046 x 49 on second case
11004 vs 15852 on third case
11004 vs 11043, 11046 x 37

I was under impression you use 11000-11001 for infected skin, 11004-11006 for necrotizing soft tissue infection and 11042-11047 for wound/ulcer debridement. Since the exact location is external genitalia/perineum (inner thigh) would 11004 be correct? Any suggestions or clarification?

FIRST PROCEDURE DATE (4 IN ALL)

Postoperative Diagnosis
Necrotizing soft tissue infection of the left thigh with wound size of 20 x 40 cm

Procedure
Sharp debridement of the left thigh/perineum skin, subcutaneous tissue, muscle and fascia with a total debridement area of 25 x 40 cm. Irrigation of the wound with Dakin's.  

Procedure in Detail
Patient with history of necrotizing soft tissue infection of the left inner thigh/perineum. .....we used Bovie electrocautery to debride the dead skin and subcutaneous tissue.  We also had to use curved Mayo to completely remove this.  After we got all the skin and soft tissue away from the concerning area, we found that there was muscle and fascia that was nonviable, this was debrided too under sharp dissection.  We were able to perform this sharp dissection until we were able to get to tissue that was viable showing us positive bright red bleeding.  At this point, we packed the wound with Dakin's dressing.  We will plan to return to the operating suite tomorrow for an additional debridement.


SECOND PROCEDURE DATE

Postoperative Diagnosis
Necrotizing fasciitis of the left perineum.

Procedure
Sharp debridement of left thigh, subcutaneous tissue, muscle and fascia.  The wound area of approximately 25 x 40 cm

Procedure in Detail
Patient with history of necrotizing soft tissue infection of left thigh. ......We used Bovie electrocautery to debride necrotic subcutaneous tissue as well as a small area of removal of muscle.  There was some bright red bleeding after this dissection.  No further tracking of the wound or nonviable tissue was noted.  Wound packed with moist to dry Kerlix and procedure discontinued.

THIRD PROCEDURE

Postoperative Diagnosis
Necrotizing fasciitis of the left perineum.

Procedure
Wound VAC removal, debridement of subcutaneous and soft tissue and wet to dry dressing placement.

Procedure in Detail

Previous wound VAC was removed.  It was noted that there was some gross ______ of the wound given its proximity to the rectum.  Pulse lavage was used to irrigate and clean the soft tissues.  Healthy pink viable tissue was noted throughout the wound bed.  Moist to dry Kerlix was placed in the wound bed.

FOURTH PROCEDURE

Postoperative Diagnosis
Necrotizing fasciitis of left inner thigh/perineum.

Procedure
Irrigation and wash out of left thigh wound.
Sharp excisional debridement of skin, subcutaneous tissue and muscle covering 42 x 18 cm area
VAC assisted wound therapy greater than 50 sq cm

Procedure in Detail
Pt had previous debridement and wound VAC placement.  Patient brought back to OR for further debridement and application of wound VAC under anesthesia.  .....Using a Bovie electrocautery, scissors and scalpel, the patient's wound was debrided.   This area debridement included skin, subcutaneous tissue and muscle.  The total defect size of this wound was 42 cm x 18 cm after hemostasis was properly achieved with Bovie electrocautery, a wound VAC was placed with assistance of wound team.

Thank you.


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## cynthiabrown (Aug 14, 2014)

I think 11004 on 1,2,4    and dressing change on 3. you have dx to support 11004 which does not have add on for extra area which is kinda a pain to get paid sometimes


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## surgerycoder (Aug 15, 2014)

Thanks Cynthia, that is what I was thinking, now to convince my docs.


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