# Need help wiith irrigation of hip wound.  Please!



## klbecker (Jun 22, 2011)

I need help with a CPT code for this procedure.  I cannot find a code for the irrigation.  Any suggestions are greatly appreciated
Thanks

POSTOPERATIVE DIAGNOSIS:
     Draining wound, left hip.

OPERATION PERFORMED:
     Repeat washout with insertion of Hickman catheter for long-term
     intraarticular antibiotic delivery.

ANESTHESIA:
     General.

DESCRIPTION OF PROCEDURE:
     The patient was been receiving preoperative antibiotics.  He was brought to the operating room and general anesthesia was given.  He was placed in the lateral decubitus position, held in place with a deflated bean bag.  The left hip and lower extremity was prepped and draped in a sterile fashion. Following this, the old incision was opened.  The wound VAC sponge was removed from the deep tissue.  The wound looked very good.  It had nice beefy red appearance, good granulation tissue and no evidence of any purulence.  We did an extensive irrigation using pulse lavage with  antibiotic solution and a total of 9 liters of irrigation was washed. Digital palpation of the wound surfaces was done during the entire time.

     A direct intraarticular antibiotic delivery device was made.  A Hickman catheter was placed percutaneously and transmuscular through the anterior distal thigh and brought into the wound.  The Hickman catheter then had multiple holes pierced in it with an 18 gauge needle over a course of about 10 inches.  The end of the Hickman catheter was tied with a Vicryl suture so that it was closed off.  The Hickman catheter then had sterile saline solution pushed through it manually and this behaved essentially as a soaker hose and had spraying throughout the entire length of the catheter.  This was then placed along the entire length of the prosthesis.

     The wound was then closed in layers.  The deep layer was closed with a #1 double stranded PDS suture in a running fashion.  Wound edges were approximated with #2 Quill suture, running subcuticular.  The entire incision was able to be closed.  The wound was then covered with a wound VAC sponge and activated to -125 mm continuous negative suction.  The patient is taken to recovery in stable condition after tolerating the procedure well.


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## Jan Dalton (Jun 22, 2011)

Reading the notes I would say 26990


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## maryanneheath (Jun 22, 2011)

I'm sorry but I do not agree as this was not an abscess or a hematoma.  I would speak with your doctor, but my idea would be 27030, arthrotomy, hip, with drainage (eg, infection).  It sounds like the doctor went all along the prosthesis, so to me he was at the joint.  Just my opinion!


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## campy1961 (Jun 24, 2011)

I agree that 27030 should be used. All the physician did was drain the infection out per the op note.  The op note does not mention an abscess or hematoma so 26990 would be incorrect.  

Hope this helps


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