# Post surgical abdominal wall exploration, debridement, and irrigation wound cpt code



## loriroberts36 (Jan 27, 2017)

The patient recently had herniorrhaphy with mesh a few weeks prior with another surgeon.  Soon after he developed an abscess and went to a separate wound clinic where they did an I&D of the abscess which was noted to have MRSA.  He is now at a different facility and sees my surgeon at the hospital.  He performs the following procedure.

POSTOPERATIVE DIAGNOSIS:* Postsurgical abdominal wall abscess.
*
PROCEDURES PERFORMED:
1. Exploration of abdominal wall abscess.
2. Debridement of 100 square centimeter with sharp debridement.
3. Pulsavac/irrigation of abdominal wall.
*
ANESTHESIA:* General.
*
INDICATIONS FOR PROCEDURE:* This 51-year-old male, who recently underwent an
umbilical herniorrhaphy with mesh.* He states a couple of weeks afterwards, he
started noticing a pocket of fluid was concern and saw surgeon.* The surgeon
did not prescribe any antibiotics.* Following that he did present to the Wound
Care Clinic and was noted to have an abscess.* It was drained and noted to
have MRSA.* With the drainage, the area was packed and started on antibiotics.
I was then consulted for possible surgical excision of abscess.
*
DESCRIPTION OF PROCEDURE:* The patient was brought down to the preoperative
holding, identified to be the correct patient, and site was marked.* The
patient was explained risks, benefits, alternatives, and complications of
procedure, wished to have the procedure done.* Consent was signed which was
then placed on chart.* The patient was then brought back to surgical suite,
placed in supine position.* The patient was then intubated via Anesthesiology
Department and placed under general anesthesia.* The patient was then prepped
and draped in usual sterile fashion.* Time-out was then performed.* Once this
was done, I did open up the abscess and noted that there was a significant
amount of fluid in there.* This was clear in nature.* Once this was done, I
then did a sharp debridement with both electrocautery as well as knife;
however, roughly 100 square centimeter of abdominal adipose tissue.* Once this
was completed, I did note in the most right superior lateral portion of the
incision, there was a portion of exposed mesh roughly 0.5 cm x 0.5 cm.* At
this time, I did take a Pulsavac compulsive at the area significantly to allow
for getting clean edges of the tissue and allow for proper hemostasis.* Once
this was done, I then placed a Betadine-soaked Kerlix into the abdominal wound
to begin the process of getting granulation over this area to see if we can
get it to heal without any issues.* Once complete, the patient was then awoke
from anesthesia, extubated, and taken back to PACU in stable condition.* All
instrument, sponge, and needle counts were correct at the end of the
procedure, and I was present for the duration of procedure

Do I code 10180-78, I&D of complex, postoperative wound infection and 11005-78 for the extensive debridement of the 100 square centimeter of abdominal adipose tissue?  Any guidance is appreciated.


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