# Pilonidal Cystectomy help!!



## l1ttle_0ne (Sep 28, 2015)

I'm a little confused by this one. Our physician wants to charge for a complex pilonidal cystecomty 11772. However when I read the lay description of the procedure I'm not quite sure it meets the criteria. Can anyone please give me their opinion???


Preoperative Diagnosis: Pilonidal cyst (complex)

Postoperative Diagnosis: Same

Procedure: Pilonidal cystectomy (complex)

Surgeon: 


Findings: 

Pilonidal cyst found with midline pits. The tract extended 12 cm right lateral (very atypical) with no intenral opening. The entire tract had a large amount of granulation tissue present. A total of three incisions were made. The first above the tailbone, at the location of a typical pilonidal cyst (interestingly the incision did not extend cranially). The external opening was right posterior and this was opened as well. Right lateral incision was made between the two incisions down to the fistula tract. All three opening were left open. WIll plan wound care to evaluate wounds 


Procedure:

The patient was consented and brought to the operative theater. General anesthesia was administered and the patient placed in the prone jack-knife position. Peri-operative antibiotics were given. Patient then sterilely prepped and draped. 
The pilonidal cyst was then opened. The fistula tract was intubated with the lacrimal duct probe. Fistula probe then traversed the entire tract. Three incisions were made and the granulation present was cleared with curettes. The three counter incisions were then left open.
Hemostasis was excellent. Wound was then left open and packed

EBL: 25 ml
Specimen: none 
Complications: None


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## jjhamer1 (Sep 29, 2015)

I would code this as a 11771 - description below:

11770-11772 (11770, 11771, 11772)

A pilonidal cyst or sinus is entrapped epithelial tissue located in the sacrococcygeal region above the buttocks. These lesions are usually associated with ingrown hair. A sinus cavity is present and may have a fluid-producing cystic lining. With a small or simple sinus in 11770, the physician uses a scalpel to completely excise the involved tissue. The wound is sutured in a single layer. In 11771, an extensive sinus is present superficial to the fascia overlying the sacrum but with subcutaneous extensions. The physician uses a scalpel to completely excise the cystic tissue. The wound may be sutured in several layers. In 11772, the sinus involves many subcutaneous extensions superficial to the fascia overlying the sacrum. The physician uses a scalpel to completely excise the cystic tissue. Local soft tissue flaps (i.e., Z-plasty, Y-V plasty, myofasciocutaneous flap) may be required for closure of a large defect or the wound may be left open to heal by granulation.


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