# wash out of wounds



## lroebuck7 (Jun 13, 2011)

good afternoon,

i need some help please..i'm new to Trauma and General Surgery so just not sure what he is saying...

i have a General surgeon that performed a laparoscopy on 050311 reduction of a incarcerated abdominal hernia causing small bowel obstruction.she has had multiple operations asociated with this initial operation including small bowell resections due to injury to the bowel during the first operation, a leak from the bowel and mostly incision and drainage for infected pannus..

She underwent general anesthesia, she was previously intubated. Her abdomen was prepped and draped in a sterile fashionand her incisions were washed out further pulse lavage.we found a few more areas of pruulence that were not preiously drained and new sites anterior to her mons pubis site. it was also noted to be draining and this was evaluated and found to be also in continuity with all the other areas that were draining purulence.while evaluating hermidline incision, we did notice the area of the fistula and actually notice the rosycolor of the mucosa where the fistula was. I place the 24-French 3-way foley catheter into this.The balloon was not inflated and actually the balloon part was cut so that it cannot be inflated and the second lumen was clamped.The new lumen was placed to gravity.Once the area was well debrided,everything was packed once again with Kerlix..we made a second incision more dependent associated with the major pannus incision,so that drainage could occur in 2 directions. The patient has a 24-French JP drain at the base of the midline incision and the pannus incisions are all dispatched with Kerlix.


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## deborahcook4040 (Jun 14, 2011)

sounds to me like this is an I&D, complex, post-op wound infection (10180)


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## deborahcook4040 (Jun 14, 2011)

you should probably also bill the foley catheter insertion, but as the physician inserted it through a fistula of some sort and I'm not actually clear from this portion of the dictation where the catherter actually wound up in the patient; I really don't have enough information to code that. If it actually was to drain the bladder, then you might try CPT code 51040 (cystostomy with drainage). If it's just to drain the wound, then I don't think it's seperately billable.


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## lroebuck7 (Jun 16, 2011)

thank you


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