Orthopedic Coding Alert

Question: Please advise on the correct codes to use for the scenario below.

"We did an incision & drainage with debridement of fat and fascia and portion of the iliotibial band from large thigh abscess. Large abscess started near the upper thigh by the groin crease, extended down to the distal one third junction of the thigh and reached from near the anteromedial line through the femoral triangle over to the mid lateral line. The actual abscess measurements were 23x10 cm and it was full of copious amounts of purulent material. The infection did not appear to be deeper than the muscle layer. Most of the abscess was below the fascia layer although there was small abscess in the subcutaneous layer. Incision was made down through the subcutis and msucle fascia. Copious amounts of gross purulence was drained. The incision was expanded superiorly and loculations were manually broken down within the abscess to insure complete drainage. Small portions of the iliotibial band, subcutaneous fat and muscle fascia were sent for tissue cultures. Wound vac drain was applied.

Three days later I&D of subcutis and fascia was performed again. After general anesthesia, incisional wound was 15x4 cm. The abscess was seen to undermine 8cm, anteriorly 5cm, posteriorly 2cm and inferiorly zero cm. Cultures from previous I&D showed MRSA. Wound was explored and no purulence, loculations or pockets found. Wound was irrigated with pulse lavage irrigation. Some strands of iliotibial band and muscle fascia were debrided along with some subcutaneous fat from skin margin. Wound vac was applied."

For the first day would code 27301 (Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region) be appropriate? Do we report same code for the I&D on the second day? Is debridement included in the code 27301? Maybe should use 11043 (Debridement, muscle and/or fascia [includes epidermis, dermis, and subcutaneous tissue, if performed]; first 20 sq cm or less) and 11046 (Debridement, muscle and/or fascia [includes epidermis, dermis, and subcutaneous tissue, if performed]; each additional 20 sq cm, or part thereof [List separately in addition to code for primary procedure])? New Jersey Subscriber

Answer: You are correct to select code 27301 for the first day as your surgeon is draining an abscess in the thigh. You will not report another code for debridement as 27301 is inclusive of the debridement.

The CPT® procedure code 27301 has a global period of 90 days. You may report 11043 and 11046 along with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period...) or 79 (Unrelated Procedure or Service by the Same Physician During the Postoperative Period...), as applicable for the second visit.