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In coding this report that specifies a 21x18cm subcutaneous debridement, which generaded CPT 11045 an amazing 18 times, I am concerned that I am way off base.
My other question is about the "sclerosing" of the pocket. I keep getting CPT 17999 as the code for it.
See Op Report below and please offer assistance.
Thank you!
POSTOPERATIVE DIAGNOSES:
? CREST syndrome.
? 21 x 18 cm chronic seroma.
PROCEDURES PERFORMED:
? Incision and drainage of a seroma (500 mL).
? Mechanical debridement of a 21 x 18 cm subcutaneous pocket.
? Application of chemical sclerosing agent to 21 x 18 cm subcutaneous seroma pocket.
? Mechanical and chemical sclerodesis of a 21 x 18 cm subcutaneous pocket
OPERATIVE REPORT: Informed consent was obtained and the patient was taken to the operating room and prepped and draped
in a standard fashion. Prior to the induction of anesthesia, SCD boots were placed and functioning and a time-out was performed.
Antibiotics were given. I made a 4-cm incision overlying the most fluid-filled location on the patient's right lateral thigh. This
was done with a scalpel. Prior to doing so I did aspirate 60 mL of a seroma and injected in 30 mL of 1% lidocaine. I massaged
that in pretty good and then anesthetized the skin area as well with local anesthetic prior to making the incision. Upon doing so I
suctioned out a total of 500 mL of fluid, palpated around the seroma cavity and measured it to be 21 x 18 cm in greatest dimensions. There was a thick capsule on the skin side as well as overlying the muscular side as well. This was essentially chronic in nature and part of the healing process. It was similar to what I would expect to see in a peritonealized hernia sac. It
was rather thick actually and impressive. Next I took a small segment of that to send off for pathology. This was done with
electrocautery with no bleeding. Next, I mechanically abraded the entire cavity surface by using a Bovie scratch pad attached to a
ring forceps. I also used a curette as well. Once I had the surface circumferentially roughed up pretty good, I used 4 g of
aerosolized medical grade sterile talc. This was sprayed into the wound and in all aspects. Next I closed the wound with #2-0
Vicryl interrupted and #3-0 subcuticular, skin glue, and #3-0 nylon vertical mattress sutures. The wound was placed into a
compression dressing. Thigh-high TED hose were applied and then an Ace bandage was applied as a compressive dressing as
well. The patient tolerated the procedure well, had no significant pain during the procedure, and was transferred to the recovery
room in excellent condition. I will see the patient back next week. All instrument counts, laparotomy sponges, and needles were
accounted for at the time of wound closure and both Bovie scratch pads used were also accounted for at the time of wound
closure.
My other question is about the "sclerosing" of the pocket. I keep getting CPT 17999 as the code for it.
See Op Report below and please offer assistance.
Thank you!
POSTOPERATIVE DIAGNOSES:
? CREST syndrome.
? 21 x 18 cm chronic seroma.
PROCEDURES PERFORMED:
? Incision and drainage of a seroma (500 mL).
? Mechanical debridement of a 21 x 18 cm subcutaneous pocket.
? Application of chemical sclerosing agent to 21 x 18 cm subcutaneous seroma pocket.
? Mechanical and chemical sclerodesis of a 21 x 18 cm subcutaneous pocket
OPERATIVE REPORT: Informed consent was obtained and the patient was taken to the operating room and prepped and draped
in a standard fashion. Prior to the induction of anesthesia, SCD boots were placed and functioning and a time-out was performed.
Antibiotics were given. I made a 4-cm incision overlying the most fluid-filled location on the patient's right lateral thigh. This
was done with a scalpel. Prior to doing so I did aspirate 60 mL of a seroma and injected in 30 mL of 1% lidocaine. I massaged
that in pretty good and then anesthetized the skin area as well with local anesthetic prior to making the incision. Upon doing so I
suctioned out a total of 500 mL of fluid, palpated around the seroma cavity and measured it to be 21 x 18 cm in greatest dimensions. There was a thick capsule on the skin side as well as overlying the muscular side as well. This was essentially chronic in nature and part of the healing process. It was similar to what I would expect to see in a peritonealized hernia sac. It
was rather thick actually and impressive. Next I took a small segment of that to send off for pathology. This was done with
electrocautery with no bleeding. Next, I mechanically abraded the entire cavity surface by using a Bovie scratch pad attached to a
ring forceps. I also used a curette as well. Once I had the surface circumferentially roughed up pretty good, I used 4 g of
aerosolized medical grade sterile talc. This was sprayed into the wound and in all aspects. Next I closed the wound with #2-0
Vicryl interrupted and #3-0 subcuticular, skin glue, and #3-0 nylon vertical mattress sutures. The wound was placed into a
compression dressing. Thigh-high TED hose were applied and then an Ace bandage was applied as a compressive dressing as
well. The patient tolerated the procedure well, had no significant pain during the procedure, and was transferred to the recovery
room in excellent condition. I will see the patient back next week. All instrument counts, laparotomy sponges, and needles were
accounted for at the time of wound closure and both Bovie scratch pads used were also accounted for at the time of wound
closure.