Wiki Billing for re-exploration of thigh

[cbutsko]

Pt had multiple debridements due to necrotizing fasciitis, then a closure. 2 days later we took her back to the OR because of a suspicion of increasing infection again. Here's the description of the procedure. Any help in coding this would be most appreciated. I had no trouble coding the debridements and the closure. But this has me stumped. Thank you.

"...attention was then turned to the patient's right groin where her previous complex closure was observed. There was a combination of permanent suture and staples present. At the central most aspect multiple sutures and staples were removed to explore the underlying wound given recent CT scan findings concerning for infection to this area. The previous 2 JP drains were in place and appear to be servicing this area appropriately. After opening this incision, there appeared to be healthy tissue at the wound base without any additional purulence. Digital manipulation was performed and showed a small area of tracking overlying the mons pubis medially. However, there was no indication of ongoing infection and no additional purulence noted. The skin edges were excised until healthy, punctate bleeding was noted. Decision was then made to place a negative pressure wound therapy device...."

I know he referenced complex closure and it was actually intermediate, done by a partner earlier in the week. I can have that part corrected. I have the wound vac code. But I have no clue what to use for the exploration.

Thank you in advance,

Cate

 

[MI_CODER]

In the op report, your provider states "skin edges were excised until healthy, punctate bleeding was noted". I would consider this skin debridement and would code it as 97597/97598 (depending on size). There's a CCI edit between 97597/97598 and the wound vac codes so I wouldn't code for the wound vac. Be sure to query if the total wound surface area for the debridement isn't documented. I believe that the exploration would be included in the debridement.