# Need help coding debridement



## knperry (Jun 30, 2014)

I need help coding the surgery below.  I have code 10060 for I&D but I cannot decide whether or not to use 11042 or 97597 with modifier 53.  Any help will be greatly appreicated.  The notes are as follow:

PROCEDURE PERFORMED:                                                          
1.  Incision and drainage and debridement of forehead abscess.                
2.  Wound VAC placement.                                                      

ANESTHESIA:  General endotracheal, Dr. Redwood.                               

ESTIMATED BLOOD LOSS:  100 mL.                                                

COMPLICATIONS:  Bradycardia at induction and eventually PEA requiring ACLS and
chest compressions.                                                           

SPECIMENS:  Necrotic material sent for culture.                               

DISPOSITION:  Critical condition to the ICU at the completion of the          
procedure.                                                                    

INDICATION FOR PROCEDURE:  Thomas Thompson is a pleasant but unfortunate 51-year-old man who came to Atlanta Medical Center with a large abscess on his forehead.  This was initially opened in the operating room approximately 1 week prior, but progressive expansion of the wound necessitated a more aggressive debridement and opening of this abscess.  Patient was consented for debridement of his forehead and was taken to the operating room for exploration, debridement, irrigation and drainage of forehead abscess.  All risks and benefits of the procedure were explained to the patient prior to undergoing the procedure.  

 DESCRIPTION OF PROCEDURE IN DETAIL:  After informed consent was obtained, the patient was brought back to the operating room, laid supine on the operating table.  General endotracheal anesthesia was induced.  Preoperative antibiotics were given.  SCDs were placed on lower extremities and surgical pause was  conducted, correct patient and correct procedure were verified.  At this time, previous area of incision was opened both inferiorly and superiorly.  Large amounts of purulent material were expressed, and a rongeur was used to remove underlying necrotic material.  At this point, patient became bradycardic and due to the patient's instability, the procedure was terminated prior to successful removal of all necrotic material.  Wound VAC sponge was placed into the open wound, and drapes and suction were applied with good seal.  At this point, bradycardia eventually resulted in PEA.  Anesthesia department attempted pacing that was unsuccessful.  Patient received multiple rounds of ACLS drugs and _____ chest compressions with return of vital signs and was urgently transferred to the unit for further evaluation and treatment.  Necrotic material that was debrided was sent for a permanent section and  culture.  Estimated blood loss was 100 mL.  Will follow the patient once he becomes more stable in the ICU.


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## OCD_coder (Jun 30, 2014)

To error on the conservative side, since no size was documented and the provider is not discussing subq or dermis tissue being debrided I would default to the 10061 I&D, complicated due to use of a ronguer and some packing with the sponge.

Modifiers could be potentially:
58 (more extensive procedure) 
53 (discontinued procedure)

The wound vac 97597 is inclusive with either procedure and does not meet modifier 59 requirements when applied to the same wound.  The procedure is about 3 times the value of the wound vac, so it would not represent accurately the work performed.


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## lmartien (Jul 1, 2014)

I would agree with OCD Coder as there is no mention of size or depth of the wound.  However, you could potentially default to 97597/97598 instead of 10061.  The note states only necrotic tissue was removed so 11042 would not be appropriate (there is also no mention of subcutaneous tissue removed).  The vac is inclusive in the procedure.


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## knperry (Jul 1, 2014)

Thanks for the feedback!


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