Camille Posted Sat 19th of October, 2019 13:48:51 PM
Procedure Details: I identified several openings for the pilonidal cyst between the buttocks. There was also a sinus tract to the left buttock. I used a marking pent to draw elliptical lines around the sinus tracts. it measured about 5cm by 1.5 cm. I then injected 0.25% Marcaine and underlying fatty tissues. I dissected all the way down to the sacral fascia. I then used Bovie to release the pilonidal cyst containing specimen from the underlying fascia. It was sent to pathology. I then used Bovie to undermine the skin and fatty tissue from the fascia on both sides in order to be able to bring the skin edges together w/o tension. I irrigated the operative filed with the saline and ensured hemostasis. I used multiple 2/0 vicryl stitches to approximate the fatty tissues and dermal layers. The deepest layers of closure also incorporate the underlying fascia in order to reduce dead space. The skin was closed using... Would it be accurate to code this as Extensive 11771/L05.91 and if so, what are the points in this description which indicate it is more than a Simple Pilonidal 11770? Thank you very much!
SuperCoder Answered Mon 21st of October, 2019 03:24:43 AM
Thanks for your question.
Text "I dissected all the way down to the sacral fascia" and "The deepest layers of closure also incorporate the underlying fascia" shows that the cyst was deep to the subcutaneous tissue and fascia. Moreover, the wound was closed in layers with sutures. These points are sufficient to show that it should be coded to extensive i.e. 11771 (Excision of pilonidal cyst or sinus; extensive).
Please feel free to write if you have any question.