2ndry Closure or Flap? Help!!

pmogel

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My ortho did the following surgery. I'm fairly new at ortho coding and need help with this one. Any suggestions on the correct codes to use? :confused:

PROCEDURE(S):
1. Arthrotomy right knee.
2. Excisional debridement of soft tissue down to tendon in preparation
of a skin flap 27 em sq.
3. Repair of lateral retinaculum.
4. Soft tissue rearrangement 9 x 3 em equalling 27 em sq.
5. Wound closure 9 em in length intermediate.

PROCEDURE(S): Time-out was performed confirming patient, operative site, procedure, antibiotics had been received. Then began by inspecting his wound. He had several lacerations of the lateral aspect of the knee measuring 4 cm, 3 cm, and 4 cm. I carefully probed underneath these. They essentially communicated. I connected the bottom aspects of the laceration essentially creating a superior flap and an inferior flap. I then did further debridement down through the soft tissue. The laceration was found to go to the tendon of the extensor retinaculum on the lateral aspect of the knee. This was not completely through into the joint. I could not detect any penetration intraarticularly. Because of the thickness, however, of this laceration, I opted to complete the laceration and formally opened the joint performing an arthrotomy of the knee for a formal washout. This arthrotomy was approximately 2 cm in length matching the incision and the laceration. I then irrigated out his knee with a combination of pulse irrigation and 500 mL of double antibiotic solution. There was no gross blood or contamination noted within the knee. The rest of his wound was mechanically debrided of small contaminated debris and this wound was also irrigated out with 3 L of pulse lavage irrigation. After completing a thorough mechanical debridement, this also included excisional debridement of the skin edges and excisional debridement of the deeper tissue, I felt we would be able to do a soft tissue rearrangement and wound closure. I had several fingers of skin coming off my proximal flap from the lacerations. I had a more smooth curved edge of my flap distally. I had basically converted into a transverse incision. At this point in time I was able to excise the skin bridges between the lacerations and discarded this contaminated tissue. I was finally left with a wound that was 9 cm in width and 3 em in length. I was able to manipulate and rearrange the soft tissue and bring the skin edges together. Satisfied that I would be able to close the wound, I then went back to my retinaculum. I closed my retinaculum with #1 Vicryl sutures, thus closing off the joint. No other deep sutures were necessary. I then went back to my skin flaps after performing the soft tissue rearrangement for 27 em sq. I then closed the skin with 2-0
Vicryls deep followed by a 3-0 Monocryl subcuticular fashion. The final wound closure was 9 cm in length.


Thanks for any and all help! :)
Patty M, CPC
 

pmogel

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Please! Really need help on this! Here is what the surgeon wants to use:

27310-RT
15002-51
14021
13121
13122

Thank you, thank you, thank you!
Patty M, CPC
 
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