# drainage of wound?



## BFAITHFUL

patient is status post percutaneous lumbar fusion with drainage from her let paraspinal wound.  
patient admitted for wound exploration, irrigation & debridement.  Utilizing the surgical wound, the incision was opened.  A pocket of purulent material was found subcutaneous at the inferior portion of the wound.  All sutures were extracted.  Any involved subcutaneous fat and dermis was debrided.  The fascia and muscle were directly probed.  There was no rent in the fascia or muscle, and no tracking down to the hardware.  The decision was made to leave the hardware intact.  incision was irrigated out well with 6 liters of bacitracin and normal saline solution.  cultures were taken x4, two superficial in the dermis adipose tissue and two at the level of the fascia.  

Isn't this cpt 10180?


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## RebeccaWoodward*

"wound, the incision was opened. A pocket of purulent material was found subcutaneous at the inferior portion of the wound. All sutures were extracted. Any involved subcutaneous fat and dermis was debrided."

What about 20000?

*20000=*The physician creates an incision over an abscess and examines the affected area. The site is debrided and drained (20000). If the abscess is deep or complicated (20005) the physician will thoroughly debride and irrigate the area. The site is drained and the underlying tissues and bones are examined for any further signs of infection. Any dead bone or tissue is removed. The site is closed.


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## BFAITHFUL

I just found an article from neuro coding alert, stating the following:


Question: How should I report incision and drainage of a postoperative wound due to infection following a laminectomy? I-m leaning toward 10180.

Nebraska Subscriber

Answer: Until 2006, 10180 (Incision and drainage, complex, postoperative wound infection) was probably your best choice for this type of incision and drainage (I&D). Since that time, however, CPT has given you two potentially better options: 22010 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; cervical, thoracic, or cervicothoracic) and 22015 (… lumbar, sacral, or lumbosacral). You should apply these codes as appropriate to the general area (upper back or lower back) that the surgeon treats.

Remember to append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to either 22010 or 22015 when your neurosurgeon performs the I&D postoperatively during the global surgical period of the original procedure. This shows the carrier that the I&D procedure was related to the original surgical procedure.

Dx tip: To provide medical necessity for your claim, be sure that you assign an appropriate ICD-9 code for the postoperative wound infection, as well.


So what do you think about 22015, I think that's what I'm going to go with?


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## BFAITHFUL

wait, i just realized, this states deep, subfascial???


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## RebeccaWoodward*

I looked at this code too...I guess I was looking for specific words the first time around.  I can get caught up in somantics by looking for those "specific words"...

Physician documentation... "The *fascia* and muscle were directly probed. There was no rent in the fascia or muscle, and no tracking down to the hardware."...It's possible. 

22015=The CDR states..."The *deep *fascia is incised and the wound opened, irrigated, and debrided.

I know it's just one word but I like to be certain...doesn't hurt to query the physician on the actual depth.


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