# Debridement of necrotic skin flap CPT Help



## bill2doc (Nov 12, 2012)

Can anyone offer CPT help please.  Thanks so much !

Thigh was prepped and draped in standard fashion.  Upon examination, the patient was noted to have an approximately 15 x 12 cm wound with a 10 x 12 cm necrotic skin flap that was sewn in a Y formation to the surrounding tissues with what appeared to be interrupted nylon sutures.  The overlying skin was black and was swiftly becoming an eschar.  There was a foul odor that was noted.  The sutures were then removed and the skin flap was then cut from the tissue sharply.  Wound cultures were then sent.  There was tracking abscess along the gracilis muscle that was easily drained using finger dissection into the intramuscular compartment.  The underlying tissue had some necrotic debris forming a lining of the wound bed.  This was debrided sharply to healthy bleeding tissue.  The pockets were then tracked and opened into the cavity.  The skin edges were debrided back to healthy bleeding tissue and hemostasis was maintained with electrocautery.  The wound was copiously irrigated using a pulse lavage, and the underlying muscle appeared to be viable and healthy.  A wound VAC was then placed into the wound and initiated at 125 mmHg low continuous suction.  

Can I code for the VAC change??   (2nd day)
The wound VAC was removed.  Noted to have some fibrinous necrotic material which were sharply debrided from the bed of the wound.  The wound was then again examined and there is no other evidence of necrotic tissue.  The wound VAC was then placed.


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## Michele Hannon (Nov 13, 2012)

Might consider a code from the 11000's for the initial encounter. Did the second encounter require anesthesia? Consider looking at Active Wound Care Management (starting with 97597) and paying close attention to the parenthetical notes.


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## bill2doc (Nov 28, 2012)

Thanks Michele.... would 13160 fall into this procedure ???


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