GCandy
Contributor
Can anyone assist in the following case?
(The provider chose CPT 11471 Dx 705.83, for lack of a better code: Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair)
I am considering 11426 with Dx 702.8 and 705.83 with intermediate closure 12045, as there does not seem to be an available alternative for the typical hidradenitis locations: Axillary, inguinal, perineal, perianal or umbilical.
NAME OF PROCEDURE: Excision of hidradenitis from the posterior neck, complicated, complex.
JUSTIFICATION: Severely morbidly obese 17-year-old female, who presented initially about a year ago with what was felt to be a sebaceous cyst at that time on her posterior neck, comes back in and says it just keeps draining all along the back of her neck, and she just has decided she wants to go ahead and have it cut out. The area was inspected and she had sinus tracts and dimples all along the posterior neck in a horizontal fashion, extending across the creases of her neck, very close to the hair line, and in need of surgical intervention.
She was given adequate general endotracheal anesthesia and placed in the prone position. She had to have the head adjusted and the adipose tissue from her shoulders was pulled back with tape to free up the space to where it would not fold against each other, as well as the skin on the shoulders and upper arms had to be taped back to keep it from folding into the surgical field. Once this was all done, she was prepped with ChloraPrep and draped in a sterile fashion. She was injected with methylene blue and hydrogen peroxide along the dimples with some of them more difficult to inject and then some of them were very easy to inject in and I had dissected farther than I thought. The length of the incision was about 15 centimeters and the width of the incision was probably about 4 centimeters, possibly 5 in some areas. The depth was probably about 3-4 centimeters. I had to excise it down to the fascia and sometimes through the fascia to get all the blue dye out it where I had dissected down amongst each other. The area was ellipsed out, using scalpel for the skin and cautery for hemostasis and to cut out the remainder of the tissue. Once that was all done, it was closed with 2-0 Vicryl in a running fashion and then next to the fascia of the muscle and then the next layer of adipose tissue was also done with 2-0 Vicryl and then another layer of 2-0 Vicryl and then the skin was closed with 4-0 Prolene in an interrupted fashion. Once this was done, Coverderms were applied and the tape was released and the patient was scrubbed thoroughly with alcohol to clean the skin around the area. After this was done, and also prior to closing it, she was anesthetized with 0.5% Marcaine with epinephrine. She tolerated the procedure well.
(The provider chose CPT 11471 Dx 705.83, for lack of a better code: Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repair)
I am considering 11426 with Dx 702.8 and 705.83 with intermediate closure 12045, as there does not seem to be an available alternative for the typical hidradenitis locations: Axillary, inguinal, perineal, perianal or umbilical.
NAME OF PROCEDURE: Excision of hidradenitis from the posterior neck, complicated, complex.
JUSTIFICATION: Severely morbidly obese 17-year-old female, who presented initially about a year ago with what was felt to be a sebaceous cyst at that time on her posterior neck, comes back in and says it just keeps draining all along the back of her neck, and she just has decided she wants to go ahead and have it cut out. The area was inspected and she had sinus tracts and dimples all along the posterior neck in a horizontal fashion, extending across the creases of her neck, very close to the hair line, and in need of surgical intervention.
She was given adequate general endotracheal anesthesia and placed in the prone position. She had to have the head adjusted and the adipose tissue from her shoulders was pulled back with tape to free up the space to where it would not fold against each other, as well as the skin on the shoulders and upper arms had to be taped back to keep it from folding into the surgical field. Once this was all done, she was prepped with ChloraPrep and draped in a sterile fashion. She was injected with methylene blue and hydrogen peroxide along the dimples with some of them more difficult to inject and then some of them were very easy to inject in and I had dissected farther than I thought. The length of the incision was about 15 centimeters and the width of the incision was probably about 4 centimeters, possibly 5 in some areas. The depth was probably about 3-4 centimeters. I had to excise it down to the fascia and sometimes through the fascia to get all the blue dye out it where I had dissected down amongst each other. The area was ellipsed out, using scalpel for the skin and cautery for hemostasis and to cut out the remainder of the tissue. Once that was all done, it was closed with 2-0 Vicryl in a running fashion and then next to the fascia of the muscle and then the next layer of adipose tissue was also done with 2-0 Vicryl and then another layer of 2-0 Vicryl and then the skin was closed with 4-0 Prolene in an interrupted fashion. Once this was done, Coverderms were applied and the tape was released and the patient was scrubbed thoroughly with alcohol to clean the skin around the area. After this was done, and also prior to closing it, she was anesthetized with 0.5% Marcaine with epinephrine. She tolerated the procedure well.