# Debridement bone(sacrum) & I&D (Presacral)



## Trendale (Jul 28, 2011)

Hello,

Can someone share their expertise and let me know if the following surgery is coded correctly? Also a few of my concerns is: To my knowledge, precaral space is a different site than the sacrum, so I coded the I&D with a 59. One of the dx's is sepsis in which the patient was admitted for and treated with IV hydration and antibiotics, being that this is a debridement involving the skin, should this be coded as sepsis, skin-682.9 ( icd-9 refers to this code) or 038.9,995.91 ( this is the code I am going with).


PREOPERATIVE DIAGNOSES:
1  Sacral decubitus.
2  Sepsis.
POSTOPERATIVE DIAGNOSES:
1  Sacral decubitus.
2  Sepsis.
NAME OF OPERATION:
1  Debridement of sacral decubitus, including skin, soft tissue,
muscle and bone.
2  Drainage of presacral abscess.

DESCRIPTION OF OPERATION:  The patient was transported to the
operating room and placed in the supine position.  General
endotracheal anesthesia was administered.  The patient was then placed
in the prone position.  The sacral area was sterilely prepped and
draped in the usual fashion.  The circulating nurse called a surgical
time-out.  All members of the operative team were in agreement with
that process.  There was a necrotic decubitus over the sacrum.  Sharp
dissection was used to excise the skin, subcutaneous tissues and
muscle tissue including the fascia all the way to the sacrum.  A
portion of the sacrum, including the coccyx and distal sacrum was
actually also quite necrotic and was removed using the rongeur
forceps.  There were portions of the upper sacrum that were also
removed using rongeurs to adequately debride the area.  The presacral
space was entered lateral to the rectum on both sides of the midline.
The largest collection seemed to be located in the left presacral
space.  The right presacral space was also opened widely.  No
debridement was performed in this area.  The area was thoroughly
irrigated.  I should also note that the specimen was sent for Gram
stain, culture and sensitivity.  All nonviable tissue was debrided.
During the debridement, digital rectal examination was performed and
there was no sign of a rectal perforation or injury.  The wound was
irrigated copiously with normal saline.  The wound was packed open
including the presacral space using saline moistened Kerlix gauze.
Sterile dressings and ABD pads were applied.  At the completion of the
procedure, all sponge, needle and instrument counts were correct.
Estimated blood loss was 50 mL.  The patient tolerated the procedure
and returned to the intensive care unit in his preoperative condition,
which is quite serious.

The following is what I coded:
11044- 1. 707.03   2. 038.9    3. 995.91
10060-59,51  1. 682.8  2. 038.9   3.995.91

One of the coders I work with just  brought  to my attention, that he removed bone  as well and the code should be in the range of 15920 to 15945. ( see the blue highlighted area above)  If these  are the right codes to use, according to CCI, I can bill this with the 11044, but not the 11060. She also said the physician should have mentioned that the procedure would be staged being that he left the wound opened, and that I should query the doctor on that. I would probaly have to query the physician to get more detail, the report is not much to go on.

Please let me know your thoughts, and thanks in advance!


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