KBean2018
Guru
Hello,
I am not familiar with debridements, which code would I select. I know its at least 11042 but I need help with calculating area.
Findings: A small opening in the medial most left mastectomy scar with cavity beneath and more medially. However it extends more laterally and as I open the lateral incision we find the pocket continues to the anterior axillary line and cephalad, with stringy tissue debrided but then a curette required and Versajet 1 L to clean the white, devascularized exudate with minor punctate bleeding and clean at conclusion. The opening transversely is 15 cm, at the medial aspect vertically 6 cm (to the attached upper flap) and at the lateral aspect is extends beneath the non-attached upper flap toward the axilla measuring vertically 6 cm. The entire surfaces are covered with lightly soaked Betadine Kerlix and tomorrow we will ask for a wound VAC assessment.
*Indications: She is a month after post-mastectomy radiation therapy, having completed chemotherapy for high risk left-sided breast cancer. Then she had a minor separation medially with apparent evacuation of secondarily infected seroma with MRSA. She is not toxic. I advised gentle debridement with the expectation that this would be a small pocket, closed over a drain and anticipated rapid healing.
*
Description of Procedure: In the supine position with appropriate monitoring she received general anesthesia with IV antibiotic. The left torso is prepped with chlorhexidine draped after 3 minutes. The small opening is sounded, extends inferiorly beneath the flap 6 cm but the upper flap is attached. I open the incision slightly laterally and remove stringy material and there is a white covering with no visualized fascia or muscle. The stringy material is followed more laterally, tissues easily separate until ultimately the entire transverse 15 cm mastectomy scar is reopened. We debride with a avulsion technique, then used a curette but still impregnated white devascularized tissue throughout that we used the Versajet. Once this is clean, I then use half of unrolled Kerlix lightly impregnated with Betadine to lay on all the surfaces and the rest folded over and then a dry dressing applied. I did infiltrate 30 mL 0.5% Marcaine with epinephrine into the upper and lower flaps, medially and laterally for postoperative pain control. Skin is cleansed and dry dressings applied. She is awakened and extubated. Blood loss is negligible, no intraoperative cultures. She is taken to PACU.
*
I am not familiar with debridements, which code would I select. I know its at least 11042 but I need help with calculating area.
Findings: A small opening in the medial most left mastectomy scar with cavity beneath and more medially. However it extends more laterally and as I open the lateral incision we find the pocket continues to the anterior axillary line and cephalad, with stringy tissue debrided but then a curette required and Versajet 1 L to clean the white, devascularized exudate with minor punctate bleeding and clean at conclusion. The opening transversely is 15 cm, at the medial aspect vertically 6 cm (to the attached upper flap) and at the lateral aspect is extends beneath the non-attached upper flap toward the axilla measuring vertically 6 cm. The entire surfaces are covered with lightly soaked Betadine Kerlix and tomorrow we will ask for a wound VAC assessment.
*Indications: She is a month after post-mastectomy radiation therapy, having completed chemotherapy for high risk left-sided breast cancer. Then she had a minor separation medially with apparent evacuation of secondarily infected seroma with MRSA. She is not toxic. I advised gentle debridement with the expectation that this would be a small pocket, closed over a drain and anticipated rapid healing.
*
Description of Procedure: In the supine position with appropriate monitoring she received general anesthesia with IV antibiotic. The left torso is prepped with chlorhexidine draped after 3 minutes. The small opening is sounded, extends inferiorly beneath the flap 6 cm but the upper flap is attached. I open the incision slightly laterally and remove stringy material and there is a white covering with no visualized fascia or muscle. The stringy material is followed more laterally, tissues easily separate until ultimately the entire transverse 15 cm mastectomy scar is reopened. We debride with a avulsion technique, then used a curette but still impregnated white devascularized tissue throughout that we used the Versajet. Once this is clean, I then use half of unrolled Kerlix lightly impregnated with Betadine to lay on all the surfaces and the rest folded over and then a dry dressing applied. I did infiltrate 30 mL 0.5% Marcaine with epinephrine into the upper and lower flaps, medially and laterally for postoperative pain control. Skin is cleansed and dry dressings applied. She is awakened and extubated. Blood loss is negligible, no intraoperative cultures. She is taken to PACU.
*
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