Excision of sinus????

ksb0211

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Deltona, FL
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Hoping someone out there in the AAPC world will have to helpful input with this one (for both ICD-9 and CPT)....
Thanks.

PRE/POSTOPERATIVE DIAGNOSIS
Draining sinus left neck adjacent to carotid endarterectomy scar.

PROCEDURE/OPERATION
Excision of sinus.

DESCRIPTION OF PROCEDURE
The patient is brought to the operating room after the attainment of sufficient MAC anesthesia. He was pretreated with antibiotics and prepped and draped in the usual sterile fashion.

We made an incision right over the sinus. This patient is very thin and the sinus is right over the bulb of the carotid. My concern was that this may have extended down into the carotid. We excised this area of skin change and the carotid artery was directly beneath this area. There was really no coverage from previous structures over the carotid repair. Went ahead and washed it out with Betadine and then took some subcutaneous tissues on both sides and with 4-0 Vicryl with a limited footprint from foreign body, we closed the subcutaneous tissues over the carotid and then closed the skin with two interrupted sutures of 4-0 Vicryl. The patient tolerated the procedure quite well. Sterile dressing was applied. We used anesthesia with a quarter percent solution of Marcaine with epinephrine. The patient tolerated the procedure well.
 

cmartin

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I'd go w/ 1142x & 1204x. Or you might be able to do something with one of the more complicated wound closure codes, some of which include excisional preparation, w/ the persistent postop fistula dx (998.6). In ICD if you look up Sinus, draining it says see fistula.
 
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