Wiki Debridement of clavicle/chest wall with drainage of abscess

[jewlz0879]

Can someone please point me in the right direction for code selection? I don't know why this case has me unsure but it does.

Patient prepped and draped. Incision made over the mid-level of the clavicle. Physician performs clavicle and 2nd rib debridement. Because I could not drain the abcess totally just through 1 incision, I had to make a counterincision a little bit lower on the anterior chest wall towards the breast. Right lateral chest wall was prepped and drapped, a small incision was made on the right lateral chest wall and the right pleural cavity was entered sharply and not much fluid escaped. Chest tube was placed in the right pleural space and secured at the exit site....

Should I use 11044? I don't think this is right because he is not talking about debriding skin, muscle and bone.

21627 - sternal debridement?

39000 - Mediastinotomy?

Any direction or advice is greatly appreciated!

 

[lisigirl]

Actually, I think the code IS in that range (11044 - 11047) because he did debride bone - the clavicle and rib. It would be best if the size of the area debrided was documented within the note. If it is not, you must default to the smallest, which is 11044.

The surgeon did not debride the sternum so I do not think 21627 is appropriate and he did not cut into the mediastinum so I wouldn't bill 39000 either.

I would, however, bill 32551 for the chest tube in addition to 11044.

Lisi, CPC
eharkler@nmh.org