Wiki Debribement/Flaps

Kisha

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Lithonia, GA
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Need help coding this any help is appreciated.

Patient came in with a diagnosis of:Open contaminated massive degloving soft tissue injury, anteromedial forearm

Dr proposed

Debridement of devitalized skin. 11042
Elevation of the proximal skin flap to cover brachial artery, vein graft repair site. Reapplication of wound VAC. 97605

The patient was brought to the Operating Theater, positioned on a standard OR table. Pressure points padded, torso secured and the left arm on a hand table, prepped and draped. A very healthy granulation tissue appeared to be present and a small area of wound edge necrosis in the anterolateral aspect of the incision was noted. This was sharply excised, subcuticular bleeding was cauterized. 11042The wound was copiously irrigated and then a wound VAC was reapplied. Adaptic was again placed on the wound to help stimulate granulation tissue. At the close of the procedure, the wound VAC was activated. A leak was found and sealed and excellent pressure and no evidence of a functional leak was found thereafter. We did notice several of the temporary sutures that had been placed in the thumb had loosened then fallen off. The wound was resutured with 3-0 nylon. Dry sterile dressings were applied to the thumb. A posterior splint was applied to the arm
 
If the devitalized tissue was surgically excised, 15004 is appropriate to use before wound vac placement. If it was true debridement via curette, then the debridement code is appropriate. Surgeons throw the word debridement around but we have to decipher. Debridement codes (11042-11047) are meant for chronic wounds that are left to heal by secondary intention (on their own). A wound vac is considered primary intention, therefore Surgical Prep codes are appropriate (again, only if the wound is excised).
 
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