excision of umbilical abscess

nabernhardt

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I can post the op note but was trying to get any ideas. The dr thought it was umbilical hernia but ended up as an abscess and excised it. It was an exploration with excision of abscess.
 

nabernhardt

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Here is the op note.
A curvilinear incision was made below the umbilicus and the skin of the umbilicus was then
dissected from surrounding tissue as if this were an umbilical hernia. The skin was then dissected from the underlying nodule and an abscess was entered. This was cultured. The entire abscess was excised. There was a hole in the base of the umbilical skin. This was débrided. After completely removing the abscess and debriding in this manner, the area was irrigated with hydrogen peroxide solution and then rinsed aggressively with saline. After assuring adequate hemostasis and clean-out, the umbilical skin was closed with a running subcuticular 4-0 undyed suture in the deep layer and then this was reattached to the umbilical area fascia. This was with a 2-0 Vicryl. The skin was then closed in the umbilical incision with interrupted buried sutures of 4-0 undyed Vicryl.
 
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He calls it an abscess. I don't know of a code for excision of an abscess so I'll stick with incision and drainage as I previously stated. The only way I can think of to code it for an excision is if he had said he didn't know what it was and then you could consider coding it as an excision of a neoplasm of uncertain potential. But I think that's incorrect coding. Anyway, I don't think it matters here.
 

nabernhardt

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thanks for your feedback. So thinking about 2 options here possibly the I and D code with mod 22? Or maybe use and unlisted code?

what do you think?
appreciate the feedback
 

bran1120

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Did he send out any specimens for pathology other than the culture? It seems like you may want to consider an excision of a benign lesion code (11400-11406) with a closure code (probably intermediate closure 12031-12037) as well since he did a layered closure. I don't think an I&D code would be appropriate here.
 

Torilinne

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I'm curious about the physician's use of the word "nodule" along with an abscess. Then if you look at the coding guidelines for benign lesions it includes cystic lesions...hmmmm. I might also lean toward using a benign lesion excision code with a layered closure. Perhaps the provider could more appropriately help you choose??

V Davis CPC, CGIC
 
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Well I'm really curious how others come down on this issue. I have seen others code things like abscesses that were deep as excision of neoplasm of uncertain potential, subfascial. I think this is creative coding.

I know we as physicians don't like it, but we do have to live within their rules.

I still favor incision and drainage. It's not a lesion or neoplasm.
 

nabernhardt

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unfortunately no size was given nor was it sent to path. Had thought about excision of benign lesion but with no size.
 
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