# Multiple Procedures - I need help



## cvickid (Oct 30, 2008)

I need help.  

I am having some trouble with this one and thought my fellow investigators would like the challenge.  My doctor did the following:  

1) Wide excisional debridement of Stage IV sacral decubitus ulcer including skin
2)Ostectomy of the sacral bond for suspected osteomyelitis

3) Repair by transverse lumbar rotational myocutaneous flap.

4)  Repair of defect of transverse lumbar flap by creation of advancement myocutaneous flaps.

Ugh.

Any suggestion?

Thanks


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## FTessaBartels (Oct 31, 2008)

*Pressure Ulcers*

Look in CPT under Pressure Ulcers (2008 Professional edition, begins on page 67 and continues on page 68).  Be sure to read through to the end, because there is information in parenthesis regarding the flap.)

THEN ... go the section in CPT on Flaps (2008 Professional edtion, begins on page 65 and continues on page 66).  Be sure to read the guidelines. 

Without the op note I can't give you exact answers but it appears that you will probably have at least two and possibly three procedures:
1) the debridement and preparation of the ulcer for flap closure
2) the flap closure 
    and *MAYBE*
3) repair of the donor defect created by the first flap *IF *it required skin graft or local flap. 

F Tessa Bartels, CPC


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