# Clavicle/Chest wall debridement with drainage of chest wall abscess



## jewlz0879 (Aug 1, 2011)

Can someone please point me in the right direction for code selection? I don't know why this case has me unsure but it does. 

Patient prepped and draped. Incision made over the mid-level of the clavicle. Physician performs clavicle and 2nd rib debridement. Because I could not drain the abcess totally just through 1 incision, I had to make a counterincision a little bit lower on the anterior chest wall towards the breast. Right lateral chest wall was prepped and drapped, a small incision was made on the right lateral chest wall and the right pleural cavity was entered sharply and not much fluid escaped. Chest tube was placed in the right pleural space and secured at the exit site....

Should I use 11044? I don't think this is right because he is not talking about debriding skin, muscle and bone. 

21627 - sternal debridement? 

39000 - Mediastinotomy? 

Any direction or advice is greatly appreciated!


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## FTessaBartels (Aug 3, 2011)

*21627*

Here's the lay description of 21627 ... if it helps  (From Encoder Pro)

*The physician performs a debridement of the sternum. With the patient under anesthesia, the physician makes an incision in the skin overlying the sternum. The incision is carried deep to the bone. The sternum is debrided as warranted using any of a variety of hand or powered surgical instruments. Irrigation is used so that debridement can be completed as extensively as indicated. The wound may be loosely packed and a dressing applied or it may be closed in layers and a dressing applied. *

The documentation you list is very sparse. But I really do *not*see mention of the sternum at all.  

Here's the lay description of 11444  (also from Encoder Pro
*The physician surgically removes foreign matter and contaminated or devitalized bone (including epidermis, dermis, subcutaneous tissue, muscle, and/or fascia, if performed) caused by injury, infection, wounds (excluding burn wounds), or chronic ulcers. The physician uses a scalpel to excise the affected tissues into the bone. Depending on wound size, closure may be immediate or delayed. The wound may be packed open with gauze and require immediate or delayed reconstruction. Report 11044 for the first 20 sq cm or less and 11047 for each additional 20 sq cm or part thereof. * 

Again, I don't see this fully documented ... for one thing there's no mention of sq cm. (Of course, perhaps this is part of the procedure note that you didn't copy here). 


Hope this helps.

F Tessa Bartels, CPC, CEMC


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