Wiki Help with coding op report

Liz2013

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My doctor indicating on the description name of the op report: Penile fistulotomy. However, I feel that the narrative of the op report does not match and I do not seem to find a cpt code to use. I was going for the debridement code (CPT code 11004) but I am not sure. The op report indicates the following: DESCRIPTION OF PROCEDURE: After IV sedation was administered, with the patient supine, the genitalia were prepped and draped. A dorsal penile ring block was administered using 10 mL of 0.5% Marcaine. A 16-French Foley catheter was placed; efflux was clear. 10 mL were placed in the balloon.

The fistulous tract was well superficial to the Foley catheter which was palpable and separate from the fistulous tract. The fistulous tract was intubated with a lacrimal duct probe from the mid shaft opening down to the proximal opening. The tract was opened longitudinally over the lacrimal duct probe exposing the fistulous tract. There were two points of punctate purulent drainage noted, one proximally and distally along the tract. Cultures were taken and this was widely opened bluntly. The wound was then copiously irrigated.

Hemostasis was achieved. Quarter inch packing was placed along the fistula tract and a single 4-0 chromic suture was used to reapproximate the edges of the midline. Bacitracin ointment was placed. Xeroform and Kerlix were placed. The patient was brought to the recovery room in stable condition. The Foley catheter was removed.

Can you please assist or guide me? Thank you.
 
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