# pilonidal cyst , please help



## codedog (Dec 20, 2016)

not sure how to code this , i/d or 10081, or 11771? any ideas ?

PREOPERATIVE DIAGNOSIS: Pilonidal cyst with abscess.
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POSTOPERATIVE DIAGNOSIS: Pilonidal cyst with abscess.
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PROCEDURE PERFORMED: Pilonidal cyst unroofing.*
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OPERATIVE FINDINGS: A small abscess cavity approximately 4 cm length and 1 cm 
deep was appreciated. This was unroofed using Bovie electrocautery and it was 
packed.
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DESCRIPTION OF PROCEDURE: 
 upper buttocks were prepped and draped in the usual sterile fashion. An 
operative timeout was performed and the procedure began. We initially began by 
using a fistula probe and probing small midline pits, which we were unable to 
identify a true sinu. We then identified an area cephalad to the midline pits 
that looked as if it was the point of maximum erythema and attempted to probe 
this area as well. There was no entrance into the cavity. We then unroofed the
previous abscess cavity using Bovie electrocautery for approximately 4 cm in 
length and dissected down into the subcutaneous fat. We noted some fibrosed 
tracks and curetted this out using a curette and fulgurated the remaining 
surrounding tissue. We then instilled local anesthetic and packed the wound 
with dry gauze. This concluded the procedure and the patient was then awoken 
and taken to the Postanesthesia Care Unit in stable condition.
*


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## linapel (Dec 20, 2016)

When I code pilonidal cysts, I code based on the complexity of the abscess (i.e. Loculated, sinus tracts, size, depth, etc) and then I look at how the wound is left at the end of the procedure. I would code this as 10080 because the doctor packed the wound and left it open to drain. Had the doctor removed tissue and sutured this closed I would have coded it as an excision such as 11771.  The doctor didn't fully remove or excise tissue so I lean more towards an I&D over an excision.  They incised the abscess and used a curette to scrape the abscess clean and then left it open to drain. Seems also more consistent with simple 10080 rather than complicated 10081 because it seemed straight forward and didn't require things like marsupialization or primary closure and no sinu could be appreciated. A regular I&D (10060) is defined as incision and drainage for anything other than pilonidal cyst so a regular I&D code wouldn't be appropriate, either.  Hope this helps.


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## codedog (Dec 20, 2016)

thank you so much , the way you explained it makes sense thanks


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