mray906
Networker
Hello can someone take a look at this OP report and tell me if I am thinking correctly?
Doc wants to bill 2 debridments one he wants to do as the secondary closure of surgical wound after dehiscence and also wants to bill a debridement that was done in order to get to hardware that was removed. (which I believe is incidental he had to debride to get to hardware)
I am thinking 20680 and 13160 and also 97605 (for VAC application)
PREOPERATIVE DIAGNOSIS(ES):
1. Left foot wound postop wound dehiscence (ICD code 707.14).
2. Painful fixation (ICD code 996.78).
POSTOPERATIVE DIAGNOSIS(ES):
1. Left foot wound postop wound dehiscence (ICD code 707.14).
2. Painful fixation (ICD code 996.78).
OPERATION:
1. Left foot removal of fixation (CPT code 20680).
2. Left foot subcutaneous debridement (CPT code 11043).
3. Deep delayed primary closure.
PATHOLOGY: Products of fixation removal/plate and screws.
HEMOSTASIS: Left ankle tourniquet, set at 250 mmHg.
ESTIMATED BLOOD LOSS: Less than 5 cc.
MATERIALS: None.
INJECTABLES: None.
COMPLICATIONS: None.
FINDINGS: Consistent with diagnosis. Bone exposed, but appeared to be hard with no evidence of infection.
INDICATION FOR PROCEDURE: This is a 58-year-old female who presents to West Penn Hospital with a chief complaint of left foot post operative wound dehiscence, and painful hardware on the left lower extremity.
OPERATION IN DETAIL: The patient was consented for the procedure and brought outside the OR, where name and allergy bands were rechecked. The patient was brought into the OR, and placed on table in the supine position. After adequate anesthesia to the left lower extremity, the left lower extremity was prepped and draped in aseptic manner. At this time, the tourniquet was inflated. Attention was directed to the medial aspect of the left foot, where a longitudinal incision was made, extending the previously open wound along the medial aspect. The incision was taken down in a full-thickness manner, after which blunt dissection was used to expose the remaining of the already visible plate. A Wright Medical screwdriver was used to excise the screws and plate, which were all sent to Pathology. Attention was then directed to the dorsal aspect of the left foot, where a curette was used to debride the partially healed post surgical wound. Debridement was taken in a full-thickness manner to the subcu. Next, the wounds were copiously irrigated with normal saline using the pulse lavage system, after which gloves were changed, and deep wound culture was taken and sent for C and S. Next the Versajet system was used to debride the wound edges, and healthy bleeding was noted. Nonabsorbable suture was then used to close the dorsal wound of the left foot, and nonabsorbable suture was used to partially close the medial column wound. The foot was then cleansed, and new clean towels were put down, and a small wound VAC dressing was placed to complete the closure of the medial column wound. The foot was then dressed with Adaptic, 4 x 4, Webril cast padding, and Ace wrap.
Doc wants to bill 2 debridments one he wants to do as the secondary closure of surgical wound after dehiscence and also wants to bill a debridement that was done in order to get to hardware that was removed. (which I believe is incidental he had to debride to get to hardware)
I am thinking 20680 and 13160 and also 97605 (for VAC application)
PREOPERATIVE DIAGNOSIS(ES):
1. Left foot wound postop wound dehiscence (ICD code 707.14).
2. Painful fixation (ICD code 996.78).
POSTOPERATIVE DIAGNOSIS(ES):
1. Left foot wound postop wound dehiscence (ICD code 707.14).
2. Painful fixation (ICD code 996.78).
OPERATION:
1. Left foot removal of fixation (CPT code 20680).
2. Left foot subcutaneous debridement (CPT code 11043).
3. Deep delayed primary closure.
PATHOLOGY: Products of fixation removal/plate and screws.
HEMOSTASIS: Left ankle tourniquet, set at 250 mmHg.
ESTIMATED BLOOD LOSS: Less than 5 cc.
MATERIALS: None.
INJECTABLES: None.
COMPLICATIONS: None.
FINDINGS: Consistent with diagnosis. Bone exposed, but appeared to be hard with no evidence of infection.
INDICATION FOR PROCEDURE: This is a 58-year-old female who presents to West Penn Hospital with a chief complaint of left foot post operative wound dehiscence, and painful hardware on the left lower extremity.
OPERATION IN DETAIL: The patient was consented for the procedure and brought outside the OR, where name and allergy bands were rechecked. The patient was brought into the OR, and placed on table in the supine position. After adequate anesthesia to the left lower extremity, the left lower extremity was prepped and draped in aseptic manner. At this time, the tourniquet was inflated. Attention was directed to the medial aspect of the left foot, where a longitudinal incision was made, extending the previously open wound along the medial aspect. The incision was taken down in a full-thickness manner, after which blunt dissection was used to expose the remaining of the already visible plate. A Wright Medical screwdriver was used to excise the screws and plate, which were all sent to Pathology. Attention was then directed to the dorsal aspect of the left foot, where a curette was used to debride the partially healed post surgical wound. Debridement was taken in a full-thickness manner to the subcu. Next, the wounds were copiously irrigated with normal saline using the pulse lavage system, after which gloves were changed, and deep wound culture was taken and sent for C and S. Next the Versajet system was used to debride the wound edges, and healthy bleeding was noted. Nonabsorbable suture was then used to close the dorsal wound of the left foot, and nonabsorbable suture was used to partially close the medial column wound. The foot was then cleansed, and new clean towels were put down, and a small wound VAC dressing was placed to complete the closure of the medial column wound. The foot was then dressed with Adaptic, 4 x 4, Webril cast padding, and Ace wrap.