Patient is diabetic; had tranmetatarsal amputation. On f/up a month later, doctor notes: " The foot incision itself is very well healed on the plantar aspect and distal lateral aspect. There is a small area of very superficial
dehiscence central TMA about 1 cm. On the distal medial aspect there is an area of full-thickness fibrinous necrosis of the dermis and epidermis. Following debridement of that there is beefy granular tissue below with some exposed bone of the first metatarsal. No purulence, odor or exudate. No surrounding erythema or edema... No gross signs of infection."
Plan was for additional surgery: "Lengthy discussion with patient and mother regarding options. We discussed wound care versus revision surgery. Ultimately I think that with the bone exposed at the base of the wound, the
likelihood that this heals over that is low, so I think formal debridement, partial first metatarsal bone resection, maybe second metatarsal and revision closure, delayed closure, would be helpful. I think that is his best chance of getting this to heal without long-term problems and osteomyelitis."
Op notes read: "The dehisced wound was inspected for necrotic or infected tissue. Any tissue of concern was excised. There were no areas of frank pus or tracking. The remaining 1st and 2nd metatarsals were stripped with a Key periosteal elevator to expose approximately 1c, of distal metatarsal, the parabola was then adjusted with an electric saw..."
Surgery was coded as 28140 Metatarsectomy. I'm having difficulty with an appropriate diagnosis code. I attached T81.31XD for dehiscence, but there is no infection/osteomyelitis present. This was more preventative than anything.
Any feedback is appreciated.
Thank you.
dehiscence central TMA about 1 cm. On the distal medial aspect there is an area of full-thickness fibrinous necrosis of the dermis and epidermis. Following debridement of that there is beefy granular tissue below with some exposed bone of the first metatarsal. No purulence, odor or exudate. No surrounding erythema or edema... No gross signs of infection."
Plan was for additional surgery: "Lengthy discussion with patient and mother regarding options. We discussed wound care versus revision surgery. Ultimately I think that with the bone exposed at the base of the wound, the
likelihood that this heals over that is low, so I think formal debridement, partial first metatarsal bone resection, maybe second metatarsal and revision closure, delayed closure, would be helpful. I think that is his best chance of getting this to heal without long-term problems and osteomyelitis."
Op notes read: "The dehisced wound was inspected for necrotic or infected tissue. Any tissue of concern was excised. There were no areas of frank pus or tracking. The remaining 1st and 2nd metatarsals were stripped with a Key periosteal elevator to expose approximately 1c, of distal metatarsal, the parabola was then adjusted with an electric saw..."
Surgery was coded as 28140 Metatarsectomy. I'm having difficulty with an appropriate diagnosis code. I attached T81.31XD for dehiscence, but there is no infection/osteomyelitis present. This was more preventative than anything.
Any feedback is appreciated.
Thank you.
