Wiki Plastic Surgery Guidance

[CBC]

I'm new to plastic surgery coding and really need the advice of someone with experience - please! I have a couple surgeries - the first is surgical debridement (skin), application of split-thickness skin graft (125 sq cm) to right buttock (hip) pressure ulcer. The second is debridement (skin, scar, granulation tissure, bone, and elevation of tensor fascia latae flap (but not inset - failed flap)- Lt buttock. The body of the report indicates the left pressure ulcer was excised - a skin graft 14/10,000 of an inch thickness was harvested from the lt lateral thigh. Skin graft passed throught Brennen meshing machine and placed over the prepared recipient site and covered with sterile plastic netting and secured one margin with staples.
The second wound was covered with scar and granulation tissue (150 sq cm). Skin margins marked and incision of ulcer down through subcutaneous fat and underlying tensor fascia. A myocutaneous flap was elevated from distal to proximal. Despite efforts, mobilizing the falp inadequate to allow its advancement so attemp aborted. Flap returned to donor site. Open wound of ulcer covered with VAC.
Any input appreciated!!!
Thank you

 

[victoriamoll]

If the first one was truly the hip (ishium) and clearly documented as a pressure ulcer, I'd look to 15946 with 15100 and 15101 for the grafts.

Does the second one actually say pressure ulcer? And was it of the buttocks or sacrum? Because it has to state it was a pressure ulcer of either the coccyx, sacrum, ischium, or trochanter to use the designated pressure ulcer codes. If it was just a "wound" then it goes to the standard debridement, muscle flap codes that other wounds would use.

 

[CBC]

Ulcer help

Under a note findings and indications for operation: Massively obese paraplegic man developed a left buttock and right trochanteric pressure ulcer, whcih ere previously debrided. Wounds showed no evidence of infection at the time of this procedure. He also put right buttock with (hip) in parenthesis - Stage IV. The Left buttock (hip) in parentheses Stage III ulcer. I actually put 15956 & 15734 for the Rt side - but since the flap was not completed I should go to 15100?
Also on the Lt - same codes?