Wiki Debridement vs Incision and drainage / Subcutaneous vs fascia ?

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Ccgerson

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The orthopedic surgeon I code for was a co-surgeon for a case with a general surgeon. The surgery was coded as 10061 by the general surgery practice. This is an integumentary code, which doesn't allow a co-surgeon. Although neither does 11042. I'm just looking for some input whether 10061 seems like the correct code. IT is confusing, since the documentation says the incision was carried out TO the fascia, and debridement was performed "between the fascia and subcutaneous tissue".

Diagnosis : Cellulitis with edema and bulla formation no evidence of necrotic tissue, fasciitis or myonecrosis.

"Incision was made over the flexor forearm first where the majority of the bulla were located extending from the wrist to three quarters up the arm. This was carried through the skin and subcutaneous tissues down to the fascia. The muscles and tendon were visible through the fascia there was no evidence of necrotic tissue or necrotizing infection involving the subcutaneous tissue/or muscle. Hemostasis was optimized with electrocautery. The extensor surface of the arm was then carefully inspected and a 6 cm incision made from the dorsum of the hand across the wrist to the distal extensor forearm down to the fascia a copious amount of edematous fluid drained and this was cultured. A third incision was made on the more proximal extensor forearm down to the fascia where a biopsy of the subcutaneous tissues was performed using scissors and forceps. Hemostasis in both wounds were optimized. Extensive dissection between the fascia and the subcutaneous tissues were performed to maximize drainage."

Thank you,
Cindy Gerson, CPC
 
Ccgerson said:
The orthopedic surgeon I code for was a co-surgeon for a case with a general surgeon. The surgery was coded as 10061 by the general surgery practice. This is an integumentary code, which doesn't allow a co-surgeon. Although neither does 11042. I'm just looking for some input whether 10061 seems like the correct code. IT is confusing, since the documentation says the incision was carried out TO the fascia, and debridement was performed "between the fascia and subcutaneous tissue".

Diagnosis : Cellulitis with edema and bulla formation no evidence of necrotic tissue, fasciitis or myonecrosis.

"Incision was made over the flexor forearm first where the majority of the bulla were located extending from the wrist to three quarters up the arm. This was carried through the skin and subcutaneous tissues down to the fascia. The muscles and tendon were visible through the fascia there was no evidence of necrotic tissue or necrotizing infection involving the subcutaneous tissue/or muscle. Hemostasis was optimized with electrocautery. The extensor surface of the arm was then carefully inspected and a 6 cm incision made from the dorsum of the hand across the wrist to the distal extensor forearm down to the fascia a copious amount of edematous fluid drained and this was cultured. A third incision was made on the more proximal extensor forearm down to the fascia where a biopsy of the subcutaneous tissues was performed using scissors and forceps. Hemostasis in both wounds were optimized. Extensive dissection between the fascia and the subcutaneous tissues were performed to maximize drainage."

Thank you,
Cindy Gerson, CPC
Click to expand...

The necrotic tissue did not go deeper than the skin, so I agree with that part.


"A third incision was made on the more proximal extensor forearm down to the fascia where a biopsy of the subcutaneous tissues was performed using scissors and forceps. Hemostasis in both wounds were optimized. Extensive dissection between the fascia and the subcutaneous tissues were performed to maximize drainage."
Click to expand...

I'd consider billing 11100 for this part.
 
I code for upper extremity surgeons and the codes always lean towards the integumentary for I&D's, etc., but don't forget to go to the musculoskeletal chapters. For your scenario I would suggest looking at "Forearm and Wrist"... the CPT Lay Description is below:

25028-25031

The physician drains a deep abscess or hematoma in 25028 or an infected bursa in 25031 from the forearm and/or wrist. The physician makes an incision in the forearm or wrist overlying the site of the abscess, hematoma, or bursa. Dissection is carried down through the deep subcutaneous tissues and may be continued into the fascia or muscle to expose the abscess or hematoma. The incision may be extended if the mass is larger than expected. When the infected bursa, abscess, or hematoma is identified, it is incised and the contents are drained. The area is irrigated and the incision is repaired in layers with sutures, staples, and/or Steri-strips; closed with drains in place; or simply left open to further facilitate drainage of infection.

Hope this helps...
 
I don't see any documentation here that debridement was performed, but even if done, it is incidental to the I&D and shouldn't be separately reported. The biopsy would also be incidental. I agree with the previous post that you should select the most appropriate I&D code to report this procedure.
 
intra op consult

Thank you, this helps. The CPT Lay description really helped clarify what is exactly involved with 25028. I think 25028 is the most accurate CPT. With that said, the surgeon I'm coding for had not dictated a separate note initially. He added his own note, which says that this was an intra-op consult. Only the diagnosis and heading is visible right now, the rest hasn't been transcribed. Is there a code for an Intra-op consult, where the surgeon doesn't perform any of the procedure, but is there for guidance/ consult?
Also where are "Lay descriptions" of CPTs found? Coding companions?
Thank you everyone for your help.
Cindy Gerson, CPC
 
You would use consultation codes for the intraoperative consultation.

For lay descriptions, the AAPC has a Procedure Desk Reference. We use the Procedural Reference Guide for Coders and I know of the Coders' Desk Reference. I am sure there are many more options out there.
 
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