jwiles66
Networker
HAVING TROUBLE DECIDING ON CODES FOR THIS...
HOW WOULD YOU CODE THIS? 10140, 10180 OR IS IT A DEBRIDEMENT CODE?
Pre-operative Diagnosis: right calf seroma, draining
Post-operative Diagnosis: Same
Procedure: Debridement right calf wound with irrigation and closure
Indications: Ron presented unannounced to the office after a visit to the cardiologist. He did not like the appearance of the wound. I looked at the wound and while there is no obvious evidence of infection, it persists with drainage. I discussed the option of sterile irrigation in the operating room with Ron and his wife. His wife explained that they are bankrupt and cannot afford the $200 co-pay to get into the hospital for procedure. With this in mind, I have recommended the sub-optimal secondary choice of another operative procedure here in the office. I proposed to open the wound, remove at an ellipse of skin and strict sterile conditions, irrigate the cavity and introduced some alcohol into the wound to hopefully sclerose the cavity down. The subcutaneous structures will be closed as best as possible and the skin closed tightly. He understands this is not as good as the operating room first really but we all hope will be sufficient. Risks and benefits including further infection procedures were explained. He understands and agrees to proceed.
Description of procedure: Ron was placed in the supine position in the operating room. 89 paint was placed over the right leg in 3 layers. I anesthetized the wound with 1% lidocaine with epinephrine and created a small skin ellipse to remove the circular defect that was draining serous fluid. I then opened the wound and a small amount of serous fluid was identified, along with some jellylike seroma cavity fluid. There was absolutely no purulence and although I did not attempt to see it, the graft was not visible within the wound. I irrigated the cavity with peroxide twice, using full-strength solution. I then placed alcohol in the wound to attempt to act like a irritant to help close the seroma cavity. I then used Vicryl in 2 layers with interrupted sutures to close the fragile subcutaneous and fascia, pulling through several stitches. I closed the wound after cautery for bleeding control with 3-0 nylon in a running fashion. Following this, after obtaining hemostasis, I used Dermabond to attempt to seal the wound. A sterile occlusive dressing was placed in the wrist no significant blood loss.
HOW WOULD YOU CODE THIS? 10140, 10180 OR IS IT A DEBRIDEMENT CODE?
Pre-operative Diagnosis: right calf seroma, draining
Post-operative Diagnosis: Same
Procedure: Debridement right calf wound with irrigation and closure
Indications: Ron presented unannounced to the office after a visit to the cardiologist. He did not like the appearance of the wound. I looked at the wound and while there is no obvious evidence of infection, it persists with drainage. I discussed the option of sterile irrigation in the operating room with Ron and his wife. His wife explained that they are bankrupt and cannot afford the $200 co-pay to get into the hospital for procedure. With this in mind, I have recommended the sub-optimal secondary choice of another operative procedure here in the office. I proposed to open the wound, remove at an ellipse of skin and strict sterile conditions, irrigate the cavity and introduced some alcohol into the wound to hopefully sclerose the cavity down. The subcutaneous structures will be closed as best as possible and the skin closed tightly. He understands this is not as good as the operating room first really but we all hope will be sufficient. Risks and benefits including further infection procedures were explained. He understands and agrees to proceed.
Description of procedure: Ron was placed in the supine position in the operating room. 89 paint was placed over the right leg in 3 layers. I anesthetized the wound with 1% lidocaine with epinephrine and created a small skin ellipse to remove the circular defect that was draining serous fluid. I then opened the wound and a small amount of serous fluid was identified, along with some jellylike seroma cavity fluid. There was absolutely no purulence and although I did not attempt to see it, the graft was not visible within the wound. I irrigated the cavity with peroxide twice, using full-strength solution. I then placed alcohol in the wound to attempt to act like a irritant to help close the seroma cavity. I then used Vicryl in 2 layers with interrupted sutures to close the fragile subcutaneous and fascia, pulling through several stitches. I closed the wound after cautery for bleeding control with 3-0 nylon in a running fashion. Following this, after obtaining hemostasis, I used Dermabond to attempt to seal the wound. A sterile occlusive dressing was placed in the wrist no significant blood loss.