Wiki Debridement coding

ksbrickey

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I'm needing some help coding for a debridement/advancement flap closure of a postoperative leg wound. Cardiology/CT surgery are my usual, but this one has me stumped. This particular patient is 4 weeks post-op CABG and came in through ER with leg swelling/cellulitis of the incision sites of the vein harvest.

Procedure: Debridement sharply with curette down to muscle and fascia of the thigh and lower leg wound. Advancement flap creation and closure of the wound which was 6x4x3 cm for the upper leg and 18x5x2.5 cm for the lower leg. Wound VAC placement.

Description of the procedure: The patient was taken to the operating room and placed under local anesthesia. Right leg was sterilely prepped and draped in the usual manner. Both wounds were debrided using a curette sharply down to viable muscle and fascia. This was debrided back to healthy bleeding tissue. Hemostasis was obtained. Wound was irrigated with antibiotic irrigation. A 1/5 inch Penrose was placed through the tract, connecting the two wounds. Next, skin flaps were created using skin and subcutaneous tissue down just above the muscular fascia for advancement flaps. These flaps were re-approximated deeply using absorbable suture and vertical mattress nylon sutures were placed to remove tension from skin edges. At this point, portions of the wound edges remained open. Wound sponges were placed in the wounds with the sponge and Ioban above. These were subsequently connected to the suction device.

This is a new one to me, so any help would be greatly appreciated!
 
14021-XS for the upper leg wound and 14301 and 14302 for the lower leg wound (assuming the third measurement on each wound is depth). Debridement is inclusive. If it's the same surgeon who did the CABG then also add a modifier 78.
 
14021-XS for the upper leg wound and 14301 and 14302 for the lower leg wound (assuming the third measurement on each wound is depth). Debridement is inclusive. If it's the same surgeon who did the CABG then also add a modifier 78.

Yes, I've verified with the surgeon that it is the depth of the wound. Thanks for your help!
 
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