HELP! PROCEDURE: Patient was brought to the OR & given general anesthesia. The entire perineum, rectal area was prepped with Betadine & a sterile filed was created. Patient had approx a 1-inch stellate open wound with yellow & brown purulent discharge and denuded tissue with some granulation tissue midline above the rectum between and just at the base of the scrotum. Initially whatever pus was there was cleaned off & digital rectal exam was performed. Local anesethetic was used in the rectum to 4 quadrants & injecting the needle inward just beneath the mucosa, 2.5 mL were placed in all 4 quads as well as on the outside. A rectal retractor was inserted & we could easily see the rectum. There was no obvious fistula coming into the rectum, espec. anteriorly, and no erthema or sign of inflammation. There was a large amount of induration throughout this open wound but what worried & concerned me the most was that most of that induration was direct superiorly towards the base of the scrotum. A pulse lavage gun was used to clean out the area after probing multiple different holes with no end and no connection to the rectum. Once this areas was completely cleaned, I called for a consultation and a urologist came in to evaluate the area as my concern was for the possibility of an early Fournier's gangrene, which Dr. X sat, examined the patient and felt was not the case at this point, though he suggested & performed 2 incisions that connected the prior puncture wounds that had been done in the ER, thus completely opening up the perineal area. He then packed the wound & that was the end of his involvement. Patient tolerated the procedure. There were no complications. What code would the general surgeon bill for, since the urologist billed for the I&D? Thanks! (Sorry, forgot to mention a specimen was sent for culture & sensitivity which showed MRSA.)
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