lorrib
Contributor
Hi Everyone,
I am desperate and have had another coder look at two surgeries with no clue as to how to code most of it.
I am hoping someone can help me with the following two surgeries that one of our physicians performed in the span of two days. I am completely confused as to what cpt codes to utilize for the first surgery but I am wondering if cpt code 97597 or 97605 can bu used for the entire procedure.
Here are the two surgeries:
Preoperative diagnosis: Multi-trauma, left leg, with multiple abrasions and soft tissue injury.
PostOperative diagnosis: Same
Procedures:
1. Evacuation of hematoma, left calf.
2. Debridement of left ankle, skin and subcutaneous tissue. She had a 4 cm wound at the left ankle that was deep to the bone.
3. Debridement of abrasions, thigh and calf; thigh measuring 4 x 8 cm and the calf measuring 6 x 10 cm.
Description of procedure: the patient was brought to the OR. After an adequate anesthesia was obtained, she was prepped and draped in the usual manner. On the gurney before transferring her to the OR bed, her thigh and her calf were scrubbed with a scrub brush to remove the road debris. The skin cleaned up quite nicely. The embedded dirt on her foot was also cleaned up before moving her over to the OR table. We transferred her to the OR table. She was prepped and draped. Her ankle was addressed first. Skin, subcutaneous tissue, and fat were derided sharply, a few millimeters just in necrotic edges. She was explored ____ bone that was exposed. The injury did remove her periosteum on the lateral fibula, but there was no obvious fracture visible. She had some dirty debris in and around the area and this was derided with a curette. She was copiously irrigated. Her skin was closed with a 3-0 nylon just using one suture. It just was enough to cover the bone, so there would not be any desiccated bone. The rest of the wound was left widely open which was of length of about 3 cm. Attention was then turned towards the medial calf. An incision was made, approximately 4 cm, along the medial border of the tibia posterior to it. The incision was continued through skin and subcutaneous tissue. She had a huge degloved subcutaneous tissue with fatty necrosis, measuring it was approximately 9 inches x 6 inches deep in the subcutaneous. It was copiously irrigated. There was fractured necrotic fat and globules that were suctioned with irrigation out of her wound. Her skin appeared quite viable. Once we copiously irrigated to remove the majority of the necrotic fat, a large drain was placed. Her wounds were dressed with Silvaden, Xeroform gauze and Ace wrap, and she was awakened.
PreOperative Dx: Multiple abrasions, left leg; wound left lateral ankle and degloving injury, medial calf.
PostOperative Dx: Same
Procedure: Repeat debridement of lateral thigh/lateral calf wound, primary closure lateral ankle after repeat debridement and wound VAC application, medial calf.
Description of Procedure: her lateral thigh and lateral calf wound actually looked quite healthy and Endoform was used on her lateral thigh, lateral calf. This is a very large area, requiring 8 sheets of 6-inch sheeting. The lateral ankle was repeat irrigated. There was no significant necrotic debris. The wound was primarily closed with 2-0 nylon. Attention was turned to the medial calf wound. Her wound was copiously irrigated with saline and further necrotic fat was removed gently with irrigation and suction. Her skin was all viable. The muscle that was visible in the depth of wound was completely viable. A white foam was cut and placed in the undermined area. Black foam was placed on top of that and wound VAC application was set up. Feeling satisfied the wounds were dressed with Endoform, ABDs, Kerlix and Ace wrap.
I would be extremely grateful if someone could provide assistance with these surgeries.
Thank you,
Lorri
I am desperate and have had another coder look at two surgeries with no clue as to how to code most of it.
I am hoping someone can help me with the following two surgeries that one of our physicians performed in the span of two days. I am completely confused as to what cpt codes to utilize for the first surgery but I am wondering if cpt code 97597 or 97605 can bu used for the entire procedure.
Here are the two surgeries:
Preoperative diagnosis: Multi-trauma, left leg, with multiple abrasions and soft tissue injury.
PostOperative diagnosis: Same
Procedures:
1. Evacuation of hematoma, left calf.
2. Debridement of left ankle, skin and subcutaneous tissue. She had a 4 cm wound at the left ankle that was deep to the bone.
3. Debridement of abrasions, thigh and calf; thigh measuring 4 x 8 cm and the calf measuring 6 x 10 cm.
Description of procedure: the patient was brought to the OR. After an adequate anesthesia was obtained, she was prepped and draped in the usual manner. On the gurney before transferring her to the OR bed, her thigh and her calf were scrubbed with a scrub brush to remove the road debris. The skin cleaned up quite nicely. The embedded dirt on her foot was also cleaned up before moving her over to the OR table. We transferred her to the OR table. She was prepped and draped. Her ankle was addressed first. Skin, subcutaneous tissue, and fat were derided sharply, a few millimeters just in necrotic edges. She was explored ____ bone that was exposed. The injury did remove her periosteum on the lateral fibula, but there was no obvious fracture visible. She had some dirty debris in and around the area and this was derided with a curette. She was copiously irrigated. Her skin was closed with a 3-0 nylon just using one suture. It just was enough to cover the bone, so there would not be any desiccated bone. The rest of the wound was left widely open which was of length of about 3 cm. Attention was then turned towards the medial calf. An incision was made, approximately 4 cm, along the medial border of the tibia posterior to it. The incision was continued through skin and subcutaneous tissue. She had a huge degloved subcutaneous tissue with fatty necrosis, measuring it was approximately 9 inches x 6 inches deep in the subcutaneous. It was copiously irrigated. There was fractured necrotic fat and globules that were suctioned with irrigation out of her wound. Her skin appeared quite viable. Once we copiously irrigated to remove the majority of the necrotic fat, a large drain was placed. Her wounds were dressed with Silvaden, Xeroform gauze and Ace wrap, and she was awakened.
PreOperative Dx: Multiple abrasions, left leg; wound left lateral ankle and degloving injury, medial calf.
PostOperative Dx: Same
Procedure: Repeat debridement of lateral thigh/lateral calf wound, primary closure lateral ankle after repeat debridement and wound VAC application, medial calf.
Description of Procedure: her lateral thigh and lateral calf wound actually looked quite healthy and Endoform was used on her lateral thigh, lateral calf. This is a very large area, requiring 8 sheets of 6-inch sheeting. The lateral ankle was repeat irrigated. There was no significant necrotic debris. The wound was primarily closed with 2-0 nylon. Attention was turned to the medial calf wound. Her wound was copiously irrigated with saline and further necrotic fat was removed gently with irrigation and suction. Her skin was all viable. The muscle that was visible in the depth of wound was completely viable. A white foam was cut and placed in the undermined area. Black foam was placed on top of that and wound VAC application was set up. Feeling satisfied the wounds were dressed with Endoform, ABDs, Kerlix and Ace wrap.
I would be extremely grateful if someone could provide assistance with these surgeries.
Thank you,
Lorri