# wound debridements



## tgenia (Jul 27, 2012)

I was wondering if anyone can explain to me how I am supposed to add the sq cm on these multiple debridements? I can cleary see the dictation isn't the greatest, just not sure how to begin with the ones that do make sense? Thanks in advance.....Help please

Operative note:

PREOPERATIVE DIAGNOSES
1. Multiple areas of gangrene. 
2. Gangrene, right inner lower leg, measuring 13 x 10 cm. 
3. Right lower leg measuring 11 x 4 cm. 
4. Left lateral thigh measuring 24 x 8 cm. 
5. Left chest measuring 20 x 20 cm. 


POSTOPERATIVE DIAGNOSES
1. Multiple areas of gangrene. 
2. Gangrene, right inner lower leg, measuring 13 x 10 cm. 
3. Right lower leg measuring 11 x 4 cm. 
4. Left lateral thigh measuring 24 x 8 cm. 
5. Left chest measuring 20 x 20 cm. 


PROCEDURE
Debridement of above wounds. 


ESTIMATED BLOOD LOSS 
Less than 10 cc. 


COMPLICATIONS
None. 


INDICATIONS
Mr.  is a 63-year-old gentleman who was found down and had
pressure wounds and gangrene. He had been treated with Silvadene and topical
dressings, but he began to show signs of sepsis and erythema. Debridement was
considered. We discussed the potential risks, benefits, and alternatives with
his family and they elected to proceed. 


OPERATIVE FINDINGS
There was no frank purulence underneath the wounds. There was large areas of
dead skin as above. 


DESCRIPTION OF PROCEDURE
The patient was brought to the operating room, placed in supine position,
prepped and draped in the usual sterile manner. We began with the right lower
extremity. The upper inner lower right leg wound was debrided superficially.
There was an area of eschar that was excised. This measured 13 x 10 cm. The
subcutaneous tissue was fat. Viability was in question, but we only debrided
what was obviously liquefied and necrotic. There was no purulent material. 


The right lower leg was debrided similarly. There was more necrosis in the
subcutaneous space on this wound. This measured 10 x 4 cm. This necrotic
tissue was debrided. There was some bleeding suggesting viability. 


Similarly, the left thigh wound was excised. The overlying eschar was excised
and this frankly necrotic soft tissue was excised. No muscle was excised or
debrided. Some of the underlying necrotic fat was sent for culture. 


The left chest was similarly debrided. The necrosis went down to the level of
the ribs. The area of dead eschar that was excised measured 20 x 20 cm.
Again, there was liquefied fat or oil but no frank purulence. 


The wounds were dressed and the patient was return to the ICU in critical but
stable condition. There were no complications.


----------



## bill2doc (Jul 31, 2012)

Same site w/ different classification should not be added.  You need the classification then site.  Same site and classification then add.  Need to classify if they were simple, intermediate, or complex.  if all the same classificaton/site, then add.  First begin with simple, intermediate or complex. Hope that helps a little


----------



## heathermc (Aug 3, 2012)

to me it looks at though the debridements on the legs (1-3) are all down to the subq. and they can b added together.  the total i come up with is 362 cm, which would be coded as 11042 with 11045 X18 (use mod 59 on the second use of 11045 and each one thereafter).  as far as the chest, i would question the doc more on this.  not sure if it would b through the fascia (11043) or just subq since there is not alot of tissue before you hit bone.  this is my opinion.


----------



## tgenia (Aug 8, 2012)

Thank you so much for the help


----------



## cynthiabrown (Aug 8, 2012)

11045 is add-on code, never gets a mod


----------



## heathermc (Aug 9, 2012)

11045 will get a mod 59 if used more than one time.


----------

