Need a surgery pro to please assist me on this one please 
I have coded
11012
13121
13122 x 6
27310
I am not comfortable dropping my coding on this one. Help.
Thanks!
M,CCS,CPC
PREOPERATIVE DIAGNOSIS: Multiple Left lower extremity open wounds following an industrial accident
POSTOPERATIVE DIAGNOSIS:
1. Multiple Left lower extremity traumatic lacerations measuring 4cmx25cm posterolaterally, 2cmx6cm and 3cmx5cm anteromedially
2. Left knee traumatic arthrotomy
PROCEDURE PERFORMED:
1. Irrigation/Debridement Left lower extremity skin, subcutaneous tissue, fascia, muscle and bone. CPT code 11012
2. Irrigation/Debridement Left knee traumatic athrotomy
3. Complex closure, Left lower extremity wounds measuring 4cmx25cm posterolaterally, 2cmx6cm and 3cmx5cm anteromedially
4. Application of a negative pressure device, incisional wound vac, Left lower leg
FINDINGS: Multiple Left lower extremity traumatic lacerations measuring 4cmx25cm posterolaterally, 2cmx6cm and 3cmx5cm anteromedially. The proximal laceration adjacent to the medial aspect knee did violate the knee joint,representing a traumatic arthrotomy, and the distal laceration overlying the anteromedial aspect of his tibia did violate the anteromedial aspect of his tibial cortex with bone loss. Minimal contamination. Healthy appearing muscle and subcutaneous tissues following irrigation and debridement.
ESTIMATED BLOOD LOSS:
30 cc
FLUIDS:
300 cc crystalloid
TOURNIQUET TIME:
53 min
DRAINS: Provena incisional vac
COMPLICATIONS: none
CONDITION OF PATIENT ON TRANSFER: stable
OPERATIVE SUMMARY IN DETAIL:
Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of anesthesia was accomplished by the anesthesiology service. A tourniquet was applied to the patient's thigh and inflated to 300mm Hg and the Left lower extremity was prepped and draped in the usual fashion. A formal time-out was taken identifying the patient's name, operation to be performed, and operative extremity. Preoperative antibiotics were administered prior to incision. Preoperative DVT prophylaxis was administered both chemically and mechanically.
Upon inspection of the patient's lower leg had three major wounds measuring 4cmx25cm extending from the posterolateral aspect of his lower leg into the popliteal fossa, a 2cmx6cm laceration about the anteromedial aspect proximal leg which also contained a traumatic knee arthrotomy, as well as 3cmx5cm laceration about the anteromedial aspect overlying the diaphysis of his tibia. There was no significant contamination of any of his wounds, but there was some areas of devitalized skin, subcutaneous muscle, and underlying muscle adjacent to and within his lacerations. The two medial incisions were extended both proximally and distally to better visualize the extent of damage to underlying bone and soft tissue. The proximal laceration adjacent to the medial aspect knee did violate the knee joint,representing a traumatic arthrotomy, and the distal laceration overlying the anteromedial aspect of his tibia did violate the anteromedial aspect of his tibial cortex with some unicortical bone loss. Minimal contamination present. Otherwise healthy appearing muscle and subcutaneous tissues.
Following this a thorough debridement was preformed in multiple rounds until tidy surgical wounds was produced. All devitalized and necrotic tissue was sharply debrided from the skin, subcutaneous tissue, fascia, muscle and bone with measurements as above. His traumatic knee arthrotomy was also extended to better evaluate his joint and medial meniscus. No meniscal tear was identified. His lacerations and traumatic knee arthrotomy were then thoroughly irrigated with 9L of sterile saline. Following this we proceeded to close all wounds in a layered fashion including #1 Tycron for closure of his knee arthrotomy, 0-Maxon for closure of the superficial crural fascia overlying the lateral head of his gastrocnemius muscle, followed by 2-0 antibiotic coated monocryl, and 3-0 nylon for skin. Following this we applied a Provena incisional vac over his inferior wound about the anteromedial aspect of his tibia. All other wounds were covered with sterile dressings. Following this all drapes were removed and the patient was extubated and transferred to the recovery area. There were no intraoperative complications and the patient tolerated the procedure well
POST-OPERATIVE PLAN: The patient will be transferred to the floor for continued observation, pain control, and 24hrs of IV abx given his open wounds and traumatic knee arthrotomy.
I have coded
11012
13121
13122 x 6
27310
I am not comfortable dropping my coding on this one. Help.
Thanks!
M,CCS,CPC
PREOPERATIVE DIAGNOSIS: Multiple Left lower extremity open wounds following an industrial accident
POSTOPERATIVE DIAGNOSIS:
1. Multiple Left lower extremity traumatic lacerations measuring 4cmx25cm posterolaterally, 2cmx6cm and 3cmx5cm anteromedially
2. Left knee traumatic arthrotomy
PROCEDURE PERFORMED:
1. Irrigation/Debridement Left lower extremity skin, subcutaneous tissue, fascia, muscle and bone. CPT code 11012
2. Irrigation/Debridement Left knee traumatic athrotomy
3. Complex closure, Left lower extremity wounds measuring 4cmx25cm posterolaterally, 2cmx6cm and 3cmx5cm anteromedially
4. Application of a negative pressure device, incisional wound vac, Left lower leg
FINDINGS: Multiple Left lower extremity traumatic lacerations measuring 4cmx25cm posterolaterally, 2cmx6cm and 3cmx5cm anteromedially. The proximal laceration adjacent to the medial aspect knee did violate the knee joint,representing a traumatic arthrotomy, and the distal laceration overlying the anteromedial aspect of his tibia did violate the anteromedial aspect of his tibial cortex with bone loss. Minimal contamination. Healthy appearing muscle and subcutaneous tissues following irrigation and debridement.
ESTIMATED BLOOD LOSS:
30 cc
FLUIDS:
300 cc crystalloid
TOURNIQUET TIME:
53 min
DRAINS: Provena incisional vac
COMPLICATIONS: none
CONDITION OF PATIENT ON TRANSFER: stable
OPERATIVE SUMMARY IN DETAIL:
Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of anesthesia was accomplished by the anesthesiology service. A tourniquet was applied to the patient's thigh and inflated to 300mm Hg and the Left lower extremity was prepped and draped in the usual fashion. A formal time-out was taken identifying the patient's name, operation to be performed, and operative extremity. Preoperative antibiotics were administered prior to incision. Preoperative DVT prophylaxis was administered both chemically and mechanically.
Upon inspection of the patient's lower leg had three major wounds measuring 4cmx25cm extending from the posterolateral aspect of his lower leg into the popliteal fossa, a 2cmx6cm laceration about the anteromedial aspect proximal leg which also contained a traumatic knee arthrotomy, as well as 3cmx5cm laceration about the anteromedial aspect overlying the diaphysis of his tibia. There was no significant contamination of any of his wounds, but there was some areas of devitalized skin, subcutaneous muscle, and underlying muscle adjacent to and within his lacerations. The two medial incisions were extended both proximally and distally to better visualize the extent of damage to underlying bone and soft tissue. The proximal laceration adjacent to the medial aspect knee did violate the knee joint,representing a traumatic arthrotomy, and the distal laceration overlying the anteromedial aspect of his tibia did violate the anteromedial aspect of his tibial cortex with some unicortical bone loss. Minimal contamination present. Otherwise healthy appearing muscle and subcutaneous tissues.
Following this a thorough debridement was preformed in multiple rounds until tidy surgical wounds was produced. All devitalized and necrotic tissue was sharply debrided from the skin, subcutaneous tissue, fascia, muscle and bone with measurements as above. His traumatic knee arthrotomy was also extended to better evaluate his joint and medial meniscus. No meniscal tear was identified. His lacerations and traumatic knee arthrotomy were then thoroughly irrigated with 9L of sterile saline. Following this we proceeded to close all wounds in a layered fashion including #1 Tycron for closure of his knee arthrotomy, 0-Maxon for closure of the superficial crural fascia overlying the lateral head of his gastrocnemius muscle, followed by 2-0 antibiotic coated monocryl, and 3-0 nylon for skin. Following this we applied a Provena incisional vac over his inferior wound about the anteromedial aspect of his tibia. All other wounds were covered with sterile dressings. Following this all drapes were removed and the patient was extubated and transferred to the recovery area. There were no intraoperative complications and the patient tolerated the procedure well
POST-OPERATIVE PLAN: The patient will be transferred to the floor for continued observation, pain control, and 24hrs of IV abx given his open wounds and traumatic knee arthrotomy.