# hip necrosis excision????



## slc112071 (Sep 14, 2010)

Could someone please help me with the coding of this op report?  The codes that the surgeon is saying to code with are 27301 with diagnosis code 998.1.  Could I please get your opinions on this?

PREOPERATIVE DIAGNOSIS:  Status post left total hip wound hematoma with skin
necrosis.
POSTOPERATIVE DIAGNOSIS:  Status post left total hip wound hematoma with skin
necrosis.
OPERATION PERFORMED:  Excision of necrotic skin left anterior hip wound with
an incision and drainage of wound hematoma, left hip.
ANESTHESIA:  General.
ESTIMATED BLOOD LOSS:  Less than 100 mL
COMPLICATIONS:  None.
INDICATIONS:  This is a 72-year-old status post left total hip arthroplasty.
On return, she was found to have necrotic 2/3 of the mid portion of the
incision.  This was full thickness approximately 8 cm x 1 cm long.  My
recommendation was a surgical excision with debridement of the hematoma and
irrigation.  The patient was able to understand and provide informed consent.
Appropriate time out was accomplished.
SURGICAL FINDINGS:  Full thickness skin loss was found as anticipated.  The
underlying tissues were nonnecrotic that there was 100-200 old hematoma
underlying.  The fascia was not breached.
REPORT OF OPERATION:  The patient was brought to the operating suite and after
satisfactory general anesthetic had been administered, the left hip and thigh
were prepped and draped in usual sterile fashion.  An ellipsoid incision was
made to remove the necrotic skin and taken sharply down to the fatty tissues
where a large fluid collection postoperative wound hematoma was found.  This
was cultured.  The wound fluid itself appeared to be clear serous sanguinous
fluid without any purulence to it.  Gram stain and culture were sent.
Thorough irrigation was then done.  Small bleeders were electrocoagulated.
Skin was then closed using a combination of vertical mattress #2-0 and #3-0
nylons.  Sterile dressing was applied.  She was awakened and taken to the
recovery area in stable condition having tolerated the procedure well.


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## tcraft4 (Sep 15, 2010)

You might consider also 11041 for the full thickness debridement of the necrotic skin with the diagnosis 709.8 in addition to 27301 for the hematoma 998.12.  Also depending on where the patient is within the 90-day global, don't forget modifiers.


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