Trendale
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Can someone out there provide your expertise on this surgery please?
Name of Procedure: 1. Debridement skin, subqu tissues and muscle over the the medial aspect of the left foot, over the MTP joint.
2. I&D abscess on the plantar surface of the foot extending between the first and second toes, and extending to the dorsum of the foot, with debridement of skin, subqu tissues and muscles on the plantar surface of the foot, packing wounds open.
PRE OP DIAGNOSIS:
1. Necrotic wounds over the MTP joint of the left foot, 4X6cm.
2. Multiple abscesses on the dorsum and the plantar surfaces of the left foot.
Description of procedure: First, patient had a 4X8 cm area over the MTP joint where she actually had prior necrotic skin and tissue. This skina nd subq tissues and limited area of muscle on the plantar surface were debrided down to the capsule of the MTP joint; however, this did not appear to be involved.
Attention was then turned to the plantar surface of the foot. Starting at approximately the mid foot on the plantar surface, patient had a deep abscess. Therefore, the incision was started on the plantar surface of the foot and extended all the way between the first and second toes, to the dorsum of the foot. Extensive purulent drainage was identified more on the dorsum, which extended up into the mid portion of the dorsum of the foot; however, the tissue on the dorsum of the foot was much healthier. Therefore the incision was not extended beyond the MTP joint. The plantar fat pad under the third toe was necrotic and this was debrided. Extensive fatty tissue was debrided down to the muscle; as well, limited muscle was debrided. There was a small amount of bleeding from the tissues. The area unroofed on the plantar surface of the foot included approximately 4 to 5 mm wide from the first to the third metatarsals and extending all the way from the mid foot all the way to the toes. This area, after thorough debridement, was packed open with gauze. A hemostat was run under the dorsum of the foot, over the first and second metatarsals to the mid foot, to break up any further areas/pockets of purulent drainage. These areas were irrigated and then packed with gauze.
The cpt codes I have is:
11403-59
11403-59,51
10060-59,51
11043-59 ( Dorsal side ,4X8 area over the MTP) The MRi stated in the consult metioned, " The MRI of the foot shows evidence of multiple soft tissue abscesses on the dorsum of the foot as well as the plantar surface", the site was not stated in the beginning of the op report. I figured this was the dorsal side, because in the consult note he referred to the medial side as the 3X5 area, which was debrided from mid foot to 1st to 3rd metatarsals.
dx is 730.17
11043-59,51 ( Medial side, 3X5 cm area, proximal middle phalanx( mentioned on MRI), Mid foot to toes. ( from 1st to 3rd metatarsals) Plantar fat pad under 3rd toe necrotic and was debrided. Debrided down to muscle.
dx is 730.17
10060-59,51 ( I& d, plantar surface mid foot ( between 1st and 2nd toe to dorsum. with debridement.
dx is 682.7, 249.8 and 707.15
Please let me know if the DX and CPT is correct for this surgery.
On the consult note, the following dx's was diagnosed, in which I need help with as well:
1. Diabetic peripheral vessel disease and neuropathy old recluse spider bite, skin grafting dorsum of foot. 250.70,443.81 and 250.60,357.2
2. Proable osteomyelitis and abscess formation in the left foot secondary to diabetic foot ulcers. 682.7, 249.8 and 707.15
Thank you so much for your assistance!
Name of Procedure: 1. Debridement skin, subqu tissues and muscle over the the medial aspect of the left foot, over the MTP joint.
2. I&D abscess on the plantar surface of the foot extending between the first and second toes, and extending to the dorsum of the foot, with debridement of skin, subqu tissues and muscles on the plantar surface of the foot, packing wounds open.
PRE OP DIAGNOSIS:
1. Necrotic wounds over the MTP joint of the left foot, 4X6cm.
2. Multiple abscesses on the dorsum and the plantar surfaces of the left foot.
Description of procedure: First, patient had a 4X8 cm area over the MTP joint where she actually had prior necrotic skin and tissue. This skina nd subq tissues and limited area of muscle on the plantar surface were debrided down to the capsule of the MTP joint; however, this did not appear to be involved.
Attention was then turned to the plantar surface of the foot. Starting at approximately the mid foot on the plantar surface, patient had a deep abscess. Therefore, the incision was started on the plantar surface of the foot and extended all the way between the first and second toes, to the dorsum of the foot. Extensive purulent drainage was identified more on the dorsum, which extended up into the mid portion of the dorsum of the foot; however, the tissue on the dorsum of the foot was much healthier. Therefore the incision was not extended beyond the MTP joint. The plantar fat pad under the third toe was necrotic and this was debrided. Extensive fatty tissue was debrided down to the muscle; as well, limited muscle was debrided. There was a small amount of bleeding from the tissues. The area unroofed on the plantar surface of the foot included approximately 4 to 5 mm wide from the first to the third metatarsals and extending all the way from the mid foot all the way to the toes. This area, after thorough debridement, was packed open with gauze. A hemostat was run under the dorsum of the foot, over the first and second metatarsals to the mid foot, to break up any further areas/pockets of purulent drainage. These areas were irrigated and then packed with gauze.
The cpt codes I have is:
11403-59
11403-59,51
10060-59,51
11043-59 ( Dorsal side ,4X8 area over the MTP) The MRi stated in the consult metioned, " The MRI of the foot shows evidence of multiple soft tissue abscesses on the dorsum of the foot as well as the plantar surface", the site was not stated in the beginning of the op report. I figured this was the dorsal side, because in the consult note he referred to the medial side as the 3X5 area, which was debrided from mid foot to 1st to 3rd metatarsals.
dx is 730.17
11043-59,51 ( Medial side, 3X5 cm area, proximal middle phalanx( mentioned on MRI), Mid foot to toes. ( from 1st to 3rd metatarsals) Plantar fat pad under 3rd toe necrotic and was debrided. Debrided down to muscle.
dx is 730.17
10060-59,51 ( I& d, plantar surface mid foot ( between 1st and 2nd toe to dorsum. with debridement.
dx is 682.7, 249.8 and 707.15
Please let me know if the DX and CPT is correct for this surgery.
On the consult note, the following dx's was diagnosed, in which I need help with as well:
1. Diabetic peripheral vessel disease and neuropathy old recluse spider bite, skin grafting dorsum of foot. 250.70,443.81 and 250.60,357.2
2. Proable osteomyelitis and abscess formation in the left foot secondary to diabetic foot ulcers. 682.7, 249.8 and 707.15
Thank you so much for your assistance!
