Wiki I&D hand - cat bite

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RebeccaMoney

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My surgeon gave me CPT 11042 but the patient doesn't have an ulcer and I can't find a diagnosis to go with this CPT.
The op report is attached. Looks like the incision was down through subcutaneous tissue. Surrounding tissue was debrided and then saline was used to irrigate the incision. I like 11042 for this procedure but my diagnosis of cellulitis, abscess, and cat bite don't work with this.
Can anyone help ?
 

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RebeccaMoney said:
My surgeon gave me CPT 11042 but the patient doesn't have an ulcer and I can't find a diagnosis to go with this CPT.
The op report is attached. Looks like the incision was down through subcutaneous tissue. Surrounding tissue was debrided and then saline was used to irrigate the incision. I like 11042 for this procedure but my diagnosis of cellulitis, abscess, and cat bite don't work with this.
Can anyone help ?
Click to expand...
I think 11042 seems rather appropriate. The procedure report specifically says, "The surrounding tissues were debrided."

Per the CPT manual re: debridement, "These services may be reported for injuries, infections, wounds and chronic ulcers."
 
I would not use cellulitis as primary diagnosis as it is not mentioned in the operative note. Abscess is mentioned and that could be used as primary diagnosis, secondary to the cat bite. Abscess of the hand/ wrist is covered diagnoses for 11042.
 
RebeccaMoney said:
I appreciate your input. I agree and think I will go ahead and use this CPT and hope the insurance doesn't deny for diagnosis.
Thank you so much!
Click to expand...
This documentation does not support 11042 which is for subcutaneous tissue. The op note states that the tissue depth is the superficial tissues. That would most likely be the dermis and epidermis. As documented code 11042 is not supported.
 
HReed said:
I would not use cellulitis as primary diagnosis as it is not mentioned in the operative note. Abscess is mentioned and that could be used as primary diagnosis, secondary to the cat bite. Abscess of the hand/ wrist is covered diagnoses for 11042.
Click to expand...
You're correct. I'll fix my diagnosis. Thank you,
 
RebeccaMoney said:
What CPT would you suggest? Thank you,
Click to expand...
I think you need to have the provider do an addendum to clarify the deepest tissue that was debrided. At first he states the purulence was in the superficial tissue. But after the debridement he examined the tendons. He just says that the "surrounding tissues" was debrided without stating the deepest tissue. Did he debride the tendons? Possibly, but you don't know. I don't think the report is specific enough to code at this time. You need tissue depth documented.
 
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