Paula Posted Mon 16th of November, 2015 18:15:20 PM
I need some help coding a repair. This is the procedure performed:
1. Incisional debridement of left leg and knee including skin, subcutaneous tissue, fascia and muscle.
2. Secondary complicate closure of the left leg and knee wound with dimensions of 30 cm x 15 cm in multiple layers.
He used 13120 and 13122 but I do not this this is correct. Your assistance is appreciated.
Center For Orthopaedic Surgery & Sports Medicine
SuperCoder Answered Tue 17th of November, 2015 03:28:48 AM
Debridement is considered a separate procedural only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when debridement is carried out separately without immediate primary closure.
I am not clear as this is a very large closure area. Is physician using any graft to close this area? Because the complex closure CPT codes that we have only for wound closure as per length.
Please provide necessary information for this question.
Paula Posted Tue 17th of November, 2015 11:44:50 AM
DESCRIPTION OF PROCEDURE:
The patient was brought to the Operating Room, placed supine on the
operating table. No further antibiotics were needed as she just had
been. General endotracheal anesthesia was administered and the left
lower extremity from the groin distally was prepped and draped in usual
sterile fashion. The patient's wound was noted to be approximately 30
cm in a curving line from the anterior knee, just lateral to the patella,
around into the popliteal fossa with a 15 cm incision proximally along the
medial knee. The proximal 2 flaps were noted to be degloved with some
undermining of the skin on the proximal posterior flap. The wounds were
irrigated well with pulse lavage normal saline with 3 L of bacitracin added.
Any remaining debris such as grass or dirt was meticulously debrided free.
Hemostasis was obtained on supraspinatus blood vessels, 6 mL of normal saline
and bacitracin added were used to lavage the area after debriding the
appearing skin edges, subcutaneous fat, and loose fascia down into the medial
gastrocnemius. The surrounding soft tissues were infiltrated with local
anesthetic. The flaps were reapproximated to itself with subcutaneous Vicryl
sutures and then the distal flaps were repaired to the distal leg. After some
undermining of the fascial subcutaneous layer distally to free up some
tension. Subcutaneous tissues were then closed with 2-0 Vicryl suture. Skin
was closed with interrupted nylon sutures. The Sterile dressings were applied
and the patient was placed in a compressive wrap from the toes to
approximately. She was placed in a knee immobilizer and extubated and sent to
Postanesthesia Care Unit in satisfactory condition.
SuperCoder Answered Wed 18th of November, 2015 00:44:17 AM
In the above scenario, we will not use débridement code separately. We will code this services with complex closure codes only.
CPT codes used for this procedures are:
13122 x 8
Total area of closure is 45 cm.
Paula Posted Wed 18th of November, 2015 12:04:30 PM
SuperCoder Answered Thu 19th of November, 2015 00:21:18 AM