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Oversewing of lymphatic fistula

Vontresa Posted Tue 25th of September, 2012 16:11:42 PM

How would one code for incision and debridement of skin and and muscle and fascia with oversewing of lymphatic fistula. Here is the narrative:
He underwent a right groin lymph node excision for diagnosis and has developed a lymphatic fistula. The right groin was prepped and draped in a sterile fashion and a local field block anesthesia was achieved with the equal mixtures of 1% lidocaine and 0.5% Marcaine with 1:200,000 epinephrine and approximately 20 mL were infused. The incision had opened for several millimeters and was draining lymphatic fluid. Remainder of the leak incision was well healed and it was opened with the scissors. There was some exudate that was debrided free along with associated fascia and subcutaneous tissues with the wound bag clean, various portions of the wound were tied with gauze and the wound was inspected particularly with proximal massage of the leg and clear fluid could be seen to be puddling from the distinct area within the bottom portion of the wound. There, however, was no discrete vessel identified. This area was oversewn with a running #3-0 Vicryl suture and this greatly diminished the amount of clear fluid puddling in the wound. The leg drain was inserted through a separate stab wound and the wound was closed loosely with skin staples. The plan is to send the patient home with the drain in place.

SuperCoder Answered Tue 25th of September, 2012 23:17:34 PM

I could not find a proper code to describe the procedure. "This area was oversewn with a running #3-0 Vicryl suture and this greatly diminished the amount of clear fluid puddling in the wound. " is signifying an unlisted approach. I will use 38999.

I will research more on this to see if any better code exists and keep you updated.

Vontresa Posted Wed 26th of September, 2012 16:34:47 PM

Thank you.

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