Wiki Wound dehiscence help!!

[Orthosports]

Hi guys!!

Any help with coding this will be greatly appreciated. I have always been stumped. Not sure if I should just be using the wound dehiscence code or there is more work to be done.

Thanks so much!

POSTOPERATIVE DIAGNOSIS: Left leg wound dehiscence.

PROCEDURE: Left leg when debridement and scar revision with closures.

FINDINGS: The small area of open sinus, which tracked down to just some
fibrous tissue, no pocket of fluid, rest of the tissue appeared healthy.

INDICATIONS: a 42-year-old gentleman who has recently
undergone a left leg 4-compartment minimally invasive fasciotomy for
chronic exertional compartment syndrome. Postoperatively, he has had a
small area of wound dehiscence of the inferior lateral wound. This has
failed to respond to antibiotics and conservative treatment and has
remained with a very small open area, which is providing some serous
drainage. Due to this area not spontaneously closing, he has been offered
a left leg wound debridement with the scar revision and closure. Risks and
benefits of this procedure as well as the expected short and long-term
postoperative course and alternative treatments were reviewed. The patient
had full understanding and agreed to proceed.

DESCRIPTION OF PROCEDURE: The patient was met in the holding area. His
left lower extremity was initialed. He was then met by Anesthesia,
premedicated and brought to the Operating Room. In the operating room, he
was placed under general anesthesia using laryngeal mask airway. He was
positioned on the table in the supine position. Tourniquet was placed
around the left thigh. It was not used throughout the case. Left lower
extremity was prepped and draped in the usual sterile fashion. The patient
received a weight-based dose of antibiotics prior to beginning of the case. A
timeout occurred to myself, the OR staff and anesthesia staff confirming
the correct patient, site of surgery and planned surgery. Following the
timeout, an elliptical incision was made starting at the top of the
previous incision and surrounding the area of draining sinus and then
completing at the inferior aspect of the incision. The intervening skin
was then undermined using the knife and the Bovie for hemostasis. This
removed the small area of elliptical skin. At the bed of the small area of
draining sinus, there was a small amount of fibrous tissue, which was
debrided with a combination of Metzenbaum scissors and the rongeur. Tissue
deep to this was healthy. I then explored the wound. I identified the
superficial peroneal nerve, which was intact and was protected throughout
the remainder of the case. The underlying muscle and fascial tissue
appeared healthy. At this point, we debrided any fibrinous-appearing
material and then copiously irrigated the wound with the pulse irrigator.
A total of 3 liters of fluid was used. Prior to irrigation, I did obtain a
couple of deep cultures, which will be sent to the lab. After the wound
was copiously irrigated. It was then closed in layers with a 3-0 PDS for
the subcutaneous tissues and 3-0 nylon for the skin. A skin glue-type
closure was then performed on top of this as the patient was planning to go

 

[becka95]

Here is the description of 13160:

Secondary closure of an extensive or complicated surgical wound or wound dehiscence is performed. This procedure covers two scenarios, one in which the surgical wound is not closed at the time of the original surgical procedure and another in which a surgically closed wound opens along the previous suture line. Secondary surgical wound closure is performed on a date subsequent to the original surgical procedure during a separate surgical session or encounter. The edges of the open surgical wound are trimmed. The deepest layers may be closed with absorbable sutures and the knot buried followed by closure of superficial layers with non-absorbable sutures. If retention sutures are used to hold the edges of the wound together without tension, they are placed through the entire thickness of the wound, a short length of plastic or rubber tubing is threaded over each suture and each suture is then tied. Stents may also be used to hold tissue in place or maintain the opening of an orifice. Care is taken to carefully align wound edges to prevent scar depression. Secondary closure of a wound dehiscence is performed on a wound that has opened at the site of the earlier repair. The extent of the wound dehiscence is evaluated. The wound is irrigated with sterile saline or an antibiotic solution. The previously placed sutures are removed and the edges of the wound are trimmed. Any necrotic tissue is debrided. The wound is then repaired as described above.


Debridement and exploration is included in the code. I hope this helps!

 

[Orthosports]

Rebecca

Thank you - I definitely needed reassurance - sometimes when you spek to the docs they make it seem bigger than it is.

Thanks again.

Denise