# HELP! Osteomyelitis, abcess, fistula & retained Hip hardware



## joanne71178 (Jul 17, 2013)

Post OP Diagnosis: 
Left hip osteomyelitis, with retained hardware, with deep tissue fistula.

Procedure:
1. Left hip incision and drainage
2. Removal of hardware left hip under fluoroscopy guidance
3. Debridement of bone and soft tissue
4.  Excision of fistula

Operative Indications:

"the patient is a 62 year old female who is *status post left hip sliding screw fixation for fracture of the greater trochanter three years ago.  She had no immediate post op complications.  She sustained a superficial wound secondary to a recent slip and fall injury three months ago.* *Her wound continued to drain*.  She was seen by the wound care clinic.  She developed what appeared to be a deep seated infection , with continuous erythema and drainage from the wound.  *She was seen in the orthopedic office, had what appeared to be a deep fistula, and bone scan revealed osteomyelitis changes of the left hip and retained hardware.  *  The patient was on antibiotics.  Options were discussed with her an it was recommended to proceed with incisions and drainage, debridement of tissue, bone and removal of the hardware of the left hip.  ..."

Operative Technique:

"....A standard lateral hip incision was made over the previous excision site.  *The incision was ellipsed around the superficial wound, measuring approximately 4 x 4 cm, excising the infected area.  Along with the incision, there appeared to be a deep fistula at the infected site, tracking deep to the tensor fascia and overlying the sliding hip plate.  The fistula was removed; partial resection of tensor fascia was also performed.  There was a globulus chronically inflamed cystic like tissue overlying the plate that was debrided and removed.*  A screwdriver was used to remove the cortical screws from the sliding hip screw.  One cerclage wire band was able to be removed from the greater trochanter.  The remaining wire band was well fixed to the underlying one.  The visual portions of the wire were manually cut.  Attempt was made to remove the lag screw; however, failure in the extraction device was identified and the tip of the extraction device broke and was lodged into the lag screw extraction thread holes.  The lag screw was unable to be removed.  The bone was curettage and debrided using a dey elevator.  The wound was copiously irrigated with saline solution.  Fluoroscopy was used during surgery to identify the hardware.  Next the tensor fascia and IT band were closed with #2 Vicryl in interrupted figure of eight fashion.  Hemostatis was achieved using electro-cautery and bipolar cautery......."


*The Final Pathological Diagnosis is: left hip wound, excision: Dermal abscess with draining sinus tracts.* 


 Would these be the correct diagnosis codes?
905.3 (Late effect fracture of neck of femur)
730.25 (Osteomyelitis Hip),
 682.6( abscess Hip)
V54.13 (aftercare for healing traumatic fracture of hip)


I'm confused on the CPT codes for: excision of infected area, removal of fistula/partial resection of tensor fascia/inflamed cystic like tissue debrided and removed.  Would the I&D code  26990 be used plus an unlisted code 27299?

I'm comfortable coding 20680 for the hardware removal.  

Any suggestions would be great!  I'm totally stumped.  

Thanks in advance


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## joanne71178 (Jul 23, 2013)

Anyone have any thoughts?


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