# Vulvectomy vs debridement



## Babsss (Oct 15, 2018)

The surgeon put, procedure Debridement of Fournier's gangrene.  I know that normally that would send me to cpt code 11004.  My op note is more detailed than just debridement which gets me to look at cpt codes 56620 to 56633.  I lean toward 56625 due to the statement, removal of greater than 80% of the vulvar area.
I think it best to put the op note.

The necrotic tissue was debrided away with combination of sharp and cautery dissection.  The necrosis and the initial tuberosities.  The soft tissue infection extended to the left the level of the muscle fascia of the adductor compartment.  The necrotic tissue was debrided away and the process was noted to have several tunnels of erosion into the vaginal mucosa.  The breathing necrotic tissue resulted in the removal of both labia majora as well as some of the vaginal mucosa.  The rectum did not appear to be involved.  The clitoris was spared, however there was fibrinous exudate covering the surface, calling into question and its long-term viability.  The area was copiously irrigated with pulse lavage, and hemostasis was achieved with electrocautery.  Extensive tissue loss including both labia majora, the majority the mons pubis, and a significant amount of tissue involving the inner lower extremities.  The wound was packed with silver alginate, with the plan to return for diverting colostomy and wound vac at that time.
This is why I don't feel that 11004 captures the procedure.  
Diagnosis code N49.3 which started out as N76.4 on day one of inpatient date.


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