hdanner7
New
My provider documented excision of ischial pressure ulcer with debridement of the bone. Is this considered ostectomy even though he documents it as debridement? He then performs a gluteal muscle flap, so i was looking at coding 15946 and 15734.
"We began the case by marking the left ischial ulcer with methylene blue. The edges of the ischial wound were incised with 15 blade scalpel, and dissection was carried down to the level of the subcutaneous tissues using monopolar electrocautery. The ischial ulcer was systematically excised down to the level of the ischium. The ischium was then debrided by rongeur, and bone cultures were sent. In addition, soft tissue was excised and sent for culture. We then proceeded to raise a gluteal muscle flap for coverage of the fascial defect. A 12 cm incision was made from the inferior aspect of the ischial wound extending laterally along the inferior gluteal crease. Dissection was carried down to the level of the fascia using monopolar electrocautery. A lipocutaneous flap was then raised using monopolar electrocautery. The gluteus maximus was identified and incised with electrocautery to allow rotation into the ischial defect. The gluteal muscle flap was mobilized and introduced to the ischial defect and secured in place using 0 Vicryl sutures. The wound was then subsequently closed in 3 layers using 0 Vicryl sutures in Scarpa's fascia, followed by 0 Vicryl sutures in the deep dermis, followed by 0 nylon sutures for skin reapproximation. A dressing consisting of Xeroform, gauze, and ABD was applied."
"We began the case by marking the left ischial ulcer with methylene blue. The edges of the ischial wound were incised with 15 blade scalpel, and dissection was carried down to the level of the subcutaneous tissues using monopolar electrocautery. The ischial ulcer was systematically excised down to the level of the ischium. The ischium was then debrided by rongeur, and bone cultures were sent. In addition, soft tissue was excised and sent for culture. We then proceeded to raise a gluteal muscle flap for coverage of the fascial defect. A 12 cm incision was made from the inferior aspect of the ischial wound extending laterally along the inferior gluteal crease. Dissection was carried down to the level of the fascia using monopolar electrocautery. A lipocutaneous flap was then raised using monopolar electrocautery. The gluteus maximus was identified and incised with electrocautery to allow rotation into the ischial defect. The gluteal muscle flap was mobilized and introduced to the ischial defect and secured in place using 0 Vicryl sutures. The wound was then subsequently closed in 3 layers using 0 Vicryl sutures in Scarpa's fascia, followed by 0 Vicryl sutures in the deep dermis, followed by 0 nylon sutures for skin reapproximation. A dressing consisting of Xeroform, gauze, and ABD was applied."