# Debridement and I&D of foot



## Trendale

Can someone out there provide your expertise on this surgery please?
Name of Procedure: 1. Debridement skin, subqu tissues and muscle over the the medial aspect of the left foot, over the MTP joint.
2. I&D abscess on the plantar surface of the foot extending between the first and second toes, and extending to the dorsum of the foot, with debridement of skin, subqu tissues and muscles on the plantar surface of the foot, packing wounds open.

PRE OP DIAGNOSIS:
1. Necrotic wounds over the MTP joint  of the left foot, 4X6cm.
2. Multiple abscesses on the dorsum and the plantar surfaces of the left foot.

Description of procedure: First, patient had a 4X8 cm area over the MTP joint where she actually had prior necrotic skin and tissue. This skina nd subq tissues and limited area of muscle on the plantar surface were debrided down to the capsule of the MTP joint; however, this did not appear to be involved.
Attention was then turned to the plantar surface of the foot. Starting at approximately the mid foot on the plantar surface, patient had a deep abscess. Therefore, the incision was started on the plantar surface of the foot and extended all the way between the first and second toes, to the dorsum of the foot. Extensive purulent drainage was identified more on the dorsum, which extended up into the mid portion of the dorsum of the foot; however, the tissue on the dorsum of the foot was much healthier. Therefore the incision was not extended beyond the MTP joint.     The plantar fat pad under the third toe was necrotic and this was debrided. Extensive fatty tissue was debrided down to the muscle; as well, limited muscle was debrided. There was a small amount of bleeding from the tissues. The area unroofed on the plantar surface of the foot included approximately 4 to 5 mm wide from the first to the third metatarsals and extending all the way from the mid foot all the way to the toes. This area, after thorough debridement, was packed open with gauze. A hemostat was run under the dorsum of the foot, over the first and second metatarsals to the mid foot, to break up any further areas/pockets of purulent drainage. These areas were irrigated and then packed with gauze.

The cpt codes I have is:
11403-59
11403-59,51
10060-59,51

11043-59 ( Dorsal side ,4X8 area over the MTP)  The MRi stated in the consult metioned, " The MRI of the foot shows evidence of multiple soft tissue abscesses on the dorsum of the foot as well as the plantar surface", the site was not stated in the beginning of the op report. I figured this was the dorsal side, because in the consult note he referred to the medial side as the 3X5 area, which was debrided from mid foot to 1st to 3rd metatarsals.
dx is 730.17

11043-59,51 ( Medial side, 3X5 cm area, proximal middle phalanx( mentioned on MRI), Mid foot to toes. ( from 1st to 3rd metatarsals) Plantar fat pad under 3rd toe necrotic and was debrided. Debrided down to muscle. 
dx is 730.17


10060-59,51 ( I& d, plantar surface  mid foot ( between 1st and 2nd toe to dorsum. with debridement.
dx is 682.7, 249.8 and 707.15

Please let me know if the DX and CPT is correct for this surgery.


On the consult note, the following dx's was diagnosed, in which I need help with as well:

1. Diabetic peripheral vessel disease and neuropathy old recluse spider bite, skin grafting dorsum of foot. 250.70,443.81 and 250.60,357.2

2. Proable osteomyelitis and abscess formation in the left foot secondary to diabetic foot ulcers. 682.7, 249.8 and 707.15

Thank you so much for your assistance!


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## twosmek

I can tell you that you need to code the debridment codes as follows as they are the same depth. 
11043 for the first 20 square cm and then 
11046 x 2 for the remaining 40 sq cm. 

And I think you would only code the debridment codes as I think the I&D's would be included. 
I don't believe you can use other documents to justify the coding--the document needs to be able to stand alone.


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## Trendale

*Reply to debridement/I&D*

Thank you so much for looking at this!  I
actually read it again, and realized that the guidelines for debridement has been revised, in which the depth and the sqcm play a key role. After reading it again I came up with codes 11043 and 11045 and you are right the I&d is included. Also, I shouldn't go by other reports other than what is in the actual op report. I gave you measurements that was included in another note, (which I shouldn't have as you mentioned, that is why I think you came up with 11046 x2.) I typed up and summarized the op report and included info from the consult report.
In the actual report the only measrements given was 4X8 which would be 32 sqcm= 11043 and 11045.  11043 for the first 20sqcm and then 11045 for the remainder 12sqcm.

Thanks again, you confirmed my understanding of this!


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## twosmek

You should use 11046 not 11045--11046 goes with 11043 and 11045 goes with 11042!!


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## EmilyCavuoti

If the I & D is on a seperate area from where the debridement took place ( a different part of the foot) it can be coded seperatly.


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## rajkumar295

*Procedure*

Wound Debridement Procedure Note
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Diagnosis: No diagnosis found.
Indication for Procedure: at risk care
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Consent: Written and/or verbal consent was obtained including indication, risks, benefits, adverse effects and alternative therapies available.
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Timeout: A pre-procedure verification was performed. The correct patient, correct procedure, and correct site were verified prior to the initiation of this procedure. All active participants were in agreement. 
*
Procedure Description: The wound on the right foot was cleansed and prepped with Betadine. The area was not anesthetized.
The type of debridement was non-excisional.  Curette was used to debride the wound to the level of capsule.  All nonviable tissue was removed.  The size of the wound debrided was 0.3 cm x 2.2 cm x 1.0 cm.  The appearance of the wound after debridement was clean bleeding base.  There was negligible blood loss and any active bleeding during the procedure was controlled by compression.  The wound was dressed with compression dressing.  
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Outcomes: The patient tolerated the procedure well and left the office with vitals signs stable, pain free, and without any active drainage or other complications.
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Medications:  All medications for this procedure today were supplied by the practice.
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Post procedural instructions were reviewed with the patient and given to the patient in written and/or verbal form.
*


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