Question Debridement vs surgical prep?

hedmiston

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Should the following debridement be coded as 11042 & 11045 x6 with modifier 59 as it bundles with 15738? Or should it be coded as surgical prep 15002 & 15003? Should modifier 52 be added to 15738 x2 for readvancement of flaps?

POSTOPERATIVE DIAGNOSES:
1. Necrosis of left TFL flap.
2. Necrosis of left posterior thigh fasciocutaneous flap.

PROCEDURES PERFORMED:
1. Debridement of left old TFL flap measuring 8 x 6 cm.
2. Debridement of left old posterior thigh fasciocutaneous flap measuring 10 x 8 cm.
3. Secondary complex closure of surgical wound with readvancement of left posterior thigh fasciocutaneous flap based on perforators of the profunda artery and vein as well as the left tensor fascia latae flap based on the ascending branch of the lateral circumflex femoral artery and vein.

INDICATIONS FOR PROCEDURE: Patient previously had closure of his pressure sores with multiple flaps. The tensor fascia latae flap as well as the posterior thigh fasciocutaneous flap were necrotic on the distal aspect and therefore it was elected to take the patient back to the operating room for debridement of this.

DESCRIPTION OF PROCEDURE: The patient's buttock was prepped and draped in usual sterile fashion using Betadine. First attention was turned towards debridement of the distal aspect of the left TFL and fasciocutaneous posterior thigh flap. This was performed using a #10 blade through the skin and subcutaneous tissue and removing all of the devitalized tissue until healthy bleeding tissue was achieved from the flap. The total area of debridement for the TFL flap was 8 x 6 cm and the posterior thigh fasciocutaneous flap was 10 x 8 cm. Next, the prior sutures and staples that were in place holding the viable portion of the flaps in place were removed and finger dissection was performed between the healing edges of the flap. The flaps were then elevated based on the perforators of the profunda artery and the ascending branch of the lateral circumflex femoral artery and readvanced to the midline and sutured in place using a 2-0 Vicryl suture in a Scarpa's closure fashion followed by a 3-0 Monocryl suture in a deep dermal fashion and skin staples. A 4-0 nylon suture was used in some of the more tenuous areas in order to reapproximate the skin. The patient tolerated the procedure well. There were no unanticipated events. At the end of the procedure, all needles and instruments were accounted for.

Thank you in advance,
Hope
 
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