# Orthopedic surgery - I am in need of some help



## katiejeanne (Dec 31, 2010)

I am in need of some help with 2 procedures within 3 days....
We have a patient who came in and had an I&D of an abscess/osteomyelitis of the 2nd metatarsal with removal of a little bone and the incision was left open to drain. The patient returned 3 days later to have the area debrided and then sutured closed. The surgery department wants to charge with CPT 28005 for the first procedure, then 20005 (I&D) and 13160 (late closure of wound) for the second procedure. I am supposed to approve of this and I am not sure this coding is appropriate and I don't want to overcharge the patient. Does anyone have any suggestions about this? Would a modifier -52 be needed on the first procedure? I've never had to code a situation like this...Thanks in advance for any help!!!

Summarized OP Report for procedure #1
Procedure: Incision and drainage of left 2nd MPJ.
....Two semi-elliptical incisions were placed over the ulceration on the plantar aspect of his left 2nd MPJ. The redundant skin and abscess tissue was all debrided and removed from the operating field.  There was some purulent drainage noted.  The bone did have some good viability, but there was some brownish discoloration plantarly, so at this time using the sagittal saw, the 2nd metatarsal head was then resected and excised from the operating field.  The base of the proximal phalanx also appeared to have some discoloration so this was also resected at the base of the 2nd digit.  The area was flushed with saline, retention sutures were then placed with 3-0 nylon and was packed with iodoform gauze packing....the plan is to do incision and drainage on Thursday afternoon to clean out the joint and possibly secondarily close the area.

Summarized OP Report for procedure #2, 3 days later
Procedure: Incision and drainage with secondary closure of the left foot.
....The retention sutures were removed and the area was debrided with a #15 blade and fibrous debris was removed.  No purulent drainage was noted. Good granular tissue was noted already. The area was flushed with saline and cultures taken. The surgical site and incision was then reapproximated with 3-0 nylon in a simple interrupted-type fashion....

Katie


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## katiejeanne (Jan 5, 2011)

*forgot to mention...*

I forgot to add that in the description of the primary procedure (CPT 28005) it states "secondary closure is performed approximately 3 weeks later". Does that mean that when I code the second I&D that the closure shouldn't be coded separately? Any thoughts??
Also I think I am going to use modifier -58 on the second procedure instead of -52.
Katie


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## katiejeanne (Jan 12, 2012)

*Please help! Same situation again...*

This exact situation has happened again, and I got no responses last time and I still am unsure how to code these out. I am wanting to go with either 28005 or 28022 for the first procedure. The surgeon told me "yeah, either one of those would work"...I  am leaning more towards the arthotomy code.
For the 2nd procedure a few days later, I am wanting to use 11043 for the debridement and 13160-58 (since it was a staged secondary closure). Our charge is built for almost $5000 for CPT code 13160!  I just wanted to verify that it is what I should be using or if I should just stick to 11043. I need help! Thanks guys,
Katie


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## maryanneheath (Jan 12, 2012)

Hi Katie,

I'll take a stab at this, just my opinion....

I believe that for the first procedure, 28005 is the correct CPT code to use, as it specifically states osteomyelitis.  However, for the second procedure, I would only bill for the 13160.  I do not believe that the 20005 code would be correct.  I would lean more toward 11043.  However, this is bundled into the 13160, therefore, I would only bill for the secondary closure, and not the I&D.  Hope this helps you in some way.


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## twosmek (Jan 16, 2012)

I would have coded it the same way. 28005 for the 1st procedure/day and then the 13160 with a 58 modifier for the 2nd. 
the 13160 includes the debridement and closure of the wound.


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## Evelyn Kim (Jan 17, 2012)

Same here, make sure to use the 58 instead of the 52.


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## katiejeanne (Jan 18, 2012)

Thanks for your help!! Thats what I was leaning towards too, I just wish it wasn't such a high charge. It doesn't seem like it should costthat much, but it is what it is! Thanks again!
Katie


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