I have coded this procedure with 24105 & 10180. Physician coded it as 24147 & 10180. The problem I have with this is we don't know if it is osteomyelitis yet. Can the 24147 still be coded if it is not confirmed yet that it is osteomyelitis? Op note below. Any help with the coding of this procedure will be greatly appreciated.
PROCEDURES PERFORMED:
1. I&D right elbow.
2. Excision right olecranon bursitis.
3. Biopsy right proximal ulna bone
The patient was seen preoperatively, site was marked and
verified. She was taken back to the OR. Antibiotics were held until intraoperative cultures. Time-out
was taken at the beginning of the procedure. The arm was held raised. The tourniquet was inflated. We
used her scar along the posterior aspect of the elbow. We ellipsed the draining portion of the wound
which was in the central portion of the scar and debrided the skin back to fresh edges. We then exposed
the subcutaneous layers. She had thickened tissue consistent with scar tissue and olecranon bursitis. The
wound itself had a very hemorrhagic appearance consistent with possible infection. We sharply dissected
around the radial and ulnar aspects of the bursa and removed this with sharp dissection off the proximal
ulna and triceps. This tissue which was infected in appearance was sent off for pathology evaluation. We
also took cultures of the bursa tissue and soft tissue around the triceps insertion. The wound was then
irrigated. At this point, we identified two bony fragments along the posterior ulna which were removed
with osteotome and rongeur. We then smoothed out the posterior edge of the proximal ulna. We then
used an osteotome in order to create a window along the cortical surface of the proximal ulna. The cortex
along with cancellous bone removed, curette was sent off for pathology evaluation to rule out
osteomyelitis. We then irrigated the wound out thoroughly. At this point, the wound was then closed with
3-0 Vicryl and 3-0 nylon. She was placed in a long posterior splint in extension to rest the wound. She
tolerated the procedure well.
PROCEDURES PERFORMED:
1. I&D right elbow.
2. Excision right olecranon bursitis.
3. Biopsy right proximal ulna bone
The patient was seen preoperatively, site was marked and
verified. She was taken back to the OR. Antibiotics were held until intraoperative cultures. Time-out
was taken at the beginning of the procedure. The arm was held raised. The tourniquet was inflated. We
used her scar along the posterior aspect of the elbow. We ellipsed the draining portion of the wound
which was in the central portion of the scar and debrided the skin back to fresh edges. We then exposed
the subcutaneous layers. She had thickened tissue consistent with scar tissue and olecranon bursitis. The
wound itself had a very hemorrhagic appearance consistent with possible infection. We sharply dissected
around the radial and ulnar aspects of the bursa and removed this with sharp dissection off the proximal
ulna and triceps. This tissue which was infected in appearance was sent off for pathology evaluation. We
also took cultures of the bursa tissue and soft tissue around the triceps insertion. The wound was then
irrigated. At this point, we identified two bony fragments along the posterior ulna which were removed
with osteotome and rongeur. We then smoothed out the posterior edge of the proximal ulna. We then
used an osteotome in order to create a window along the cortical surface of the proximal ulna. The cortex
along with cancellous bone removed, curette was sent off for pathology evaluation to rule out
osteomyelitis. We then irrigated the wound out thoroughly. At this point, the wound was then closed with
3-0 Vicryl and 3-0 nylon. She was placed in a long posterior splint in extension to rest the wound. She
tolerated the procedure well.