betsycpcp
Networker
I have conflicting codes for this procedure:
Post-op diagnosis: S/P patellar tendon repair w/ MRSA infection and wound dehiscence.
Operation: Scar revision and exploration.
Anesthesia: General
After elevating the leg for several mintues, the pneumatic tourniquet was elevated to 350 mmHg. The entire incision was utilized. Up near the top there was an area of wound breakdown which was ellipsed from the wound. There was a very difficult time encountered delineating the subcutaneous tissues from the patellar tendon. To the best of our ability, we did so in achieving our wide margins. The area of major wound breakdown was noted to be in the vicinity of one of the FiberWire suture knots. We were able to identify this and remove it in its entirety. In the area where the other area of wound breakdown had occurred, we did encounter two loose strands of the FiberWire suture which were easily removed. Carefully exploring the tendon, no other visible suture was noted. We irrigated the wound with 3 liters of plain saline utilizing a pulsatile lavage. We then explored the wound further near the superior pole of the patella. There was another area that was felt to be consistent with a knot that we did remove both sharply and bluntly. This did not in any way alter the integrity of our repair. The wound was lavaged with a further 3 liters of the plain saline. The subcutaneous tissues were lightly approximated with #3-0 Vicryl. The skin was closed with #3-0 Prolene in simple and in mattress fashion. The wound was then dressed with Betandine-impregnated Adaptic and a bulky compressive dressing. The tourniquet was let down after 64 minutes. The patient was brought out of general anesthesia and returned to the recovery room having tolerated the procedure well.
We are the payer--when authorization was requested they listed 11406 as the planned procedure. The hospital billed 10121. The surgeon billed 27301. Are any of these right, and would 12020 possibly apply?
Any help would be appreciated!
Post-op diagnosis: S/P patellar tendon repair w/ MRSA infection and wound dehiscence.
Operation: Scar revision and exploration.
Anesthesia: General
After elevating the leg for several mintues, the pneumatic tourniquet was elevated to 350 mmHg. The entire incision was utilized. Up near the top there was an area of wound breakdown which was ellipsed from the wound. There was a very difficult time encountered delineating the subcutaneous tissues from the patellar tendon. To the best of our ability, we did so in achieving our wide margins. The area of major wound breakdown was noted to be in the vicinity of one of the FiberWire suture knots. We were able to identify this and remove it in its entirety. In the area where the other area of wound breakdown had occurred, we did encounter two loose strands of the FiberWire suture which were easily removed. Carefully exploring the tendon, no other visible suture was noted. We irrigated the wound with 3 liters of plain saline utilizing a pulsatile lavage. We then explored the wound further near the superior pole of the patella. There was another area that was felt to be consistent with a knot that we did remove both sharply and bluntly. This did not in any way alter the integrity of our repair. The wound was lavaged with a further 3 liters of the plain saline. The subcutaneous tissues were lightly approximated with #3-0 Vicryl. The skin was closed with #3-0 Prolene in simple and in mattress fashion. The wound was then dressed with Betandine-impregnated Adaptic and a bulky compressive dressing. The tourniquet was let down after 64 minutes. The patient was brought out of general anesthesia and returned to the recovery room having tolerated the procedure well.
We are the payer--when authorization was requested they listed 11406 as the planned procedure. The hospital billed 10121. The surgeon billed 27301. Are any of these right, and would 12020 possibly apply?
Any help would be appreciated!