KBean2018
Guru
Hello, I am leaning towards codes 11042,11045. Since the I&D had minor debridement. Please let me know your thoughts. Thank you for the help.
Procedure(s):
Debridement Soft Tissue - Arm
EACH ADDITIONAL DEBRIDEMENT
SKIN DEBRIDEMENT LEFT ANTERIOR SUPERIOR ILIAC SPINE
INCISION AND DRAINAGE AND PACKING, RIGHT AXILLA Procedure Note
Pre-op Diagnosis: Abscess of forearm, left [L02.414]
Post-op Diagnosis:
1. Large carbuncle with tissue necrosis, left proximal dorsal forearm
2. Small subcutaneous abscess, left anterior superior iliac spine (ASIS)
3. Large subcutaneous abscess, right axilla
CPT Code:
Procedure: Debridement Soft Tissue - Arm
CPT(R) Code: 11042 - PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
Procedure: EACH ADDITIONAL DEBRIDEMENT
CPT(R) Code: 11045 - PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
Procedure: SKIN DEBRIDEMENT LEFT ANTERIOR SUPERIOR ILIAC SPINE
Procedure: INCISION AND DRAINAGE AND PACKING, RIGHT AXILLA
Findings: Diffuse consolidated carbuncle with multiple pointing abscess of a raised (3cm projection) mass in the dorsal left forearm over the proximal ulna, indurated at the base, excision debridement measuring 6 x 5 cm. The base is both granulated and necrotic tissue. Once the main specimen is removed I use a #10 scalpel to scrape off the infected granulation, down to aponeurosis but not exposing bone, not exposing muscle. There is no undermining and I use compression for hemostasis. I had infiltrated 15 mL 0.5% Marcaine with epinephrine around the proposed incision line at the beginning of the case. At the left ASIS, a moist exudate is white measuring 1 x 1.5 cm, that is unroofed and that tissue submitted, similar dimensions. The more grumous tissue deep is debrided in similar fashion without undermining. I infiltrated 7 mL into the surrounding tissue. In the right axilla a 3-1/2 cm pointing abscess with central necrosis, a cruciate incision and irrigation and minor debridement, infiltrating 8 mL 0.5% Marcaine with epinephrine around the perimeter. The axilla and the left ASIS are packed with Xeroform wick. A larger Xeroform compression is placed over the 6 x 5 cm wound in the left forearm and covered with 4 x 4 gauze, Kerlix roll, and Ace wrap.
Indications: obviously neglected abscesses presents to the operating room. Once asleep, I pull off Band-Aids that we now noticed over the left ASIS and right axilla with findings as presented above. I do not have her permission to drain these 2 areas but it certainly seems logical and safer, the alternative would be to awaken her and pursue incision and drainage on another day, doubling the risks with a second anesthetic. It would seem more egregious to ignore that I cautiously debride the left ASIS and the right axilla.
Description of Procedure: In the supine position with appropriate monitoring she received general anesthesia and maintains IV antibiotic. antibody. The left forearm is exposed and prepped with Betadine and draped above the elbow and above the wrist and laid . Is laid on an arm board. We recognized two to additional bandages, left ASIS and right axilla, description as presented above. Each of these is prepped with Betadine and all exposed within surgical drapes are applied. At the left forearm I infiltrate Marcaine, also the left ASIS and in the right axilla. At the left forearm, at the edge of the maximum skin inflammation and necrosis, I use cutting mode cautery superficially and break into pus and granulation tissue with purulence. I can fracture debride the main mass and then I used a #10 blade in a sweeping motion to debride until any obviously infected dead tissue was removed. There is no undermining. I cover this. Using different instruments, I used a scalpel to excise a 1 cm plug of moist necrotic tissue from the left ASIS and I used the blade to debride surrounding tissue and could not hold pressure. In the right axilla I use cutting mode cautery for transverse and then vertical extension cruciate incision with evacuation of the base, the volume is about 7 mL. I hold pressure.
All sites of skin are cleansed, I use a Xeroform wick placed into the left ASIS, about 2 inches length, and 8 inches length in the right axilla. I used a large sheet of Xeroform firmly packing the open wound in the left forearm, with remainder dressings as described. She is awakened, extubated and transported to PACU
Procedure(s):
Debridement Soft Tissue - Arm
EACH ADDITIONAL DEBRIDEMENT
SKIN DEBRIDEMENT LEFT ANTERIOR SUPERIOR ILIAC SPINE
INCISION AND DRAINAGE AND PACKING, RIGHT AXILLA Procedure Note
Pre-op Diagnosis: Abscess of forearm, left [L02.414]
Post-op Diagnosis:
1. Large carbuncle with tissue necrosis, left proximal dorsal forearm
2. Small subcutaneous abscess, left anterior superior iliac spine (ASIS)
3. Large subcutaneous abscess, right axilla
CPT Code:
Procedure: Debridement Soft Tissue - Arm
CPT(R) Code: 11042 - PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM
Procedure: EACH ADDITIONAL DEBRIDEMENT
CPT(R) Code: 11045 - PR DEBRIDEMENT, SKIN, SUB-Q TISSUE,EACH ADD 20 SQ CM
Procedure: SKIN DEBRIDEMENT LEFT ANTERIOR SUPERIOR ILIAC SPINE
Procedure: INCISION AND DRAINAGE AND PACKING, RIGHT AXILLA
Findings: Diffuse consolidated carbuncle with multiple pointing abscess of a raised (3cm projection) mass in the dorsal left forearm over the proximal ulna, indurated at the base, excision debridement measuring 6 x 5 cm. The base is both granulated and necrotic tissue. Once the main specimen is removed I use a #10 scalpel to scrape off the infected granulation, down to aponeurosis but not exposing bone, not exposing muscle. There is no undermining and I use compression for hemostasis. I had infiltrated 15 mL 0.5% Marcaine with epinephrine around the proposed incision line at the beginning of the case. At the left ASIS, a moist exudate is white measuring 1 x 1.5 cm, that is unroofed and that tissue submitted, similar dimensions. The more grumous tissue deep is debrided in similar fashion without undermining. I infiltrated 7 mL into the surrounding tissue. In the right axilla a 3-1/2 cm pointing abscess with central necrosis, a cruciate incision and irrigation and minor debridement, infiltrating 8 mL 0.5% Marcaine with epinephrine around the perimeter. The axilla and the left ASIS are packed with Xeroform wick. A larger Xeroform compression is placed over the 6 x 5 cm wound in the left forearm and covered with 4 x 4 gauze, Kerlix roll, and Ace wrap.
Indications: obviously neglected abscesses presents to the operating room. Once asleep, I pull off Band-Aids that we now noticed over the left ASIS and right axilla with findings as presented above. I do not have her permission to drain these 2 areas but it certainly seems logical and safer, the alternative would be to awaken her and pursue incision and drainage on another day, doubling the risks with a second anesthetic. It would seem more egregious to ignore that I cautiously debride the left ASIS and the right axilla.
Description of Procedure: In the supine position with appropriate monitoring she received general anesthesia and maintains IV antibiotic. antibody. The left forearm is exposed and prepped with Betadine and draped above the elbow and above the wrist and laid . Is laid on an arm board. We recognized two to additional bandages, left ASIS and right axilla, description as presented above. Each of these is prepped with Betadine and all exposed within surgical drapes are applied. At the left forearm I infiltrate Marcaine, also the left ASIS and in the right axilla. At the left forearm, at the edge of the maximum skin inflammation and necrosis, I use cutting mode cautery superficially and break into pus and granulation tissue with purulence. I can fracture debride the main mass and then I used a #10 blade in a sweeping motion to debride until any obviously infected dead tissue was removed. There is no undermining. I cover this. Using different instruments, I used a scalpel to excise a 1 cm plug of moist necrotic tissue from the left ASIS and I used the blade to debride surrounding tissue and could not hold pressure. In the right axilla I use cutting mode cautery for transverse and then vertical extension cruciate incision with evacuation of the base, the volume is about 7 mL. I hold pressure.
All sites of skin are cleansed, I use a Xeroform wick placed into the left ASIS, about 2 inches length, and 8 inches length in the right axilla. I used a large sheet of Xeroform firmly packing the open wound in the left forearm, with remainder dressings as described. She is awakened, extubated and transported to PACU