13160 secondary closure...

miracle01

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Please help - chronic ulceration plantar aspect of foot, cleft foot deformity secondary to central ray resection, type II diabetes, osteomyelitis.

pt had chronic ulceration, being treated with wound vac and presented for definitive reconstruction. pt also had a middle ray resection performed due to osteomyelitis infection.

NOTE: I code for a ASC and do not know when the patient had the above procedures done. This wound was open and pt presented for reconstruction as mentioned above.

todays procedure: A wedge type incision was carried out to extend the ulceration towards the base of the third metatarsal. The wedge skin was excised as well as deeper tissue all the way down until a complete cleft deformity was achieved at the foot. The 3rd metatarsal was identified and the shaft and base were resected using a mirco oscillating saw.... Attention was then turned to the 2nd metatarsal, which was noted to be very soft and most likely osteomyelitic. The 2nd metatarsal head was resected. Next the plantar portion of the ulceration wound edges were freshened and the wound bed was curetted for debridement. The cleft deformity was then flushed...attention was turned to the metatarsal necks....pins were inserted into the 1st 2nd 4th & 5th metatarsal necks...(this was for application of external fixator). Placement was confirmed on fluoro. Next using the variable angle pin-to-bar components, a mini jet-x bar was used to attach all rays and the fore foot was narrowed and the external fixator was then tightened. Next, the incision was primarily closed using 4-0 nylon with retention sutures. A total closure of 14 cm was performed.

Dr. listed the following code to be used 13132 +13133 (Repair Complex), 28122, 28112 (for the 3rd & 2nd mets respectively) and finally 20690 for application of fixator.

Does this seem correct? I was wondering if I should use CPT code 13160 instead of 13132 +13133.

Thank you to anyone who might be able to help me with this!
 
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