My provider is proposing CPT codes 35860 and 64718. I agree with 64718. However, I disagree with 35860 and feel that the correct code would be 23930 for the I&D. My provider is now wanting to know why I wouldn't code 35860. My thought process on this is because 35860 is part of the cardiovascular system therefore the correct code would be 23930. I see why my provider is confused because 35860 states "exploration for postop..infection of extremity". Am I correct in my thinking or would 35860 be the better code?
Thanks in advance.
An infected abscess/hematoma of right elbow, status post ulnar nerve in situ release. Has had a draining wound for 2 weeks since surgery. Had been applying pressure directly over the elbow, despite instructions not to do so. Regardless, we discussed the risks and benefits of an irrigation and debridement of the right elbow.
The 6 cm incision was gapped open. There was clearly purulent material draining from the wound. We extended it proximally and distally. First, we identified the ulnar nerve. Had an in situ release. We had to release and complete a neurolysis to identify the nerve more proximally and distally. Once I identified more proximally, there were no obvious pockets of pus, but there was clearly infected hematoma, which had extended up the medial fascia. The fascia was split under direct visualization, protecting the nerve. We completed a thorough neurolysis through the previous site of surgery, as well as proximal and distal into the FCU and up between the triceps and the brachialis protecting the nerve throughout. We then completed a thorough debridement of the deep hematoma/abscess. The nerve stayed well behind the medial epicondyle. Once thoroughly debrided and cleaned out, we closed the wound with a 3-0 nylon, stitches will need to stay in 3 weeks. We placed a Penrose well up proximally as well as distally to allow for drainage.
Thanks in advance.
An infected abscess/hematoma of right elbow, status post ulnar nerve in situ release. Has had a draining wound for 2 weeks since surgery. Had been applying pressure directly over the elbow, despite instructions not to do so. Regardless, we discussed the risks and benefits of an irrigation and debridement of the right elbow.
The 6 cm incision was gapped open. There was clearly purulent material draining from the wound. We extended it proximally and distally. First, we identified the ulnar nerve. Had an in situ release. We had to release and complete a neurolysis to identify the nerve more proximally and distally. Once I identified more proximally, there were no obvious pockets of pus, but there was clearly infected hematoma, which had extended up the medial fascia. The fascia was split under direct visualization, protecting the nerve. We completed a thorough neurolysis through the previous site of surgery, as well as proximal and distal into the FCU and up between the triceps and the brachialis protecting the nerve throughout. We then completed a thorough debridement of the deep hematoma/abscess. The nerve stayed well behind the medial epicondyle. Once thoroughly debrided and cleaned out, we closed the wound with a 3-0 nylon, stitches will need to stay in 3 weeks. We placed a Penrose well up proximally as well as distally to allow for drainage.