cbutsko
Guest
I'd really appreciate some help with this one. Apparently I've not coded it correctly.
Preop and Postop DX: Stage IV right ischial and trochanteric ulcers status post Girdlestone procedure.
Op Summary:
1. Local myocutaneous advancement flap closure from the trunk to the Stage IV right ischial trochanteric ulcer
2. Application of negative pressure wound therapy dressing greater than 50 cm2.
Indications: This is a 34 y/0 Caucasian male patient who was admitted approximately a week ago. He underwent a loop diverting colostomy as well as a Girdlestone procedure for a nonhealing chronic stage IV right ischial and trochanteric ulcers. He has been receiving negative pressure wound therapy dressing. His colostomy is working well and he presents today for definitive closure.....
Procedure in detail: This 34 y/o Caucasian male patient was brought to the operating room, placed in the supine position, and placed under general endotracheal anesthesia......We first curettage all of the wound and the granular tissue that had accumulated over this past week with negative pressure wound therapy and we cultured some of this curetted tissue. We then utilized 3000 ml bag of normal saling for pulse irrigation for adequate irrigation and minimal hemostasis was needed. We placed two 19-French Blake drains. They are placed out laterally and secured to the skin with 2-0 nylon. We undermined cutaneously on the gluteal muscle as well as the posterior thigh muscles and, at this point in time, we placed one drain in the acetabulum and down deep around the remnant of the femoral resection. We were able to approximate the deep layers of the posterior thigh muscles with figure-of-eight stitches of - Vicryl. The gluteal muscles were then reapproximated back over the trochanteric defect with 0 Vicryl simple stitches and then the deep dermis with 0 Vicryl, the superficial dermis 3-0 Vicryl, and then the skin with 2-0 Prolene in horizontal mattress fashion.....
I originally billed it as 15734-58, 15956-58-51, and 97606-58-59. I coded this one in the very beginning, when I first started coding for plastic surgery.
Ins paid the 15956 and 97606, denied the 15734 as not documented.
Now I'm thinking I probably should have used a code from the 14XXX series for the flap however, without a measurement indicated, would I have to use lowest sq cm?
Would greatly appreciate your input!
Thanks in advance!
Preop and Postop DX: Stage IV right ischial and trochanteric ulcers status post Girdlestone procedure.
Op Summary:
1. Local myocutaneous advancement flap closure from the trunk to the Stage IV right ischial trochanteric ulcer
2. Application of negative pressure wound therapy dressing greater than 50 cm2.
Indications: This is a 34 y/0 Caucasian male patient who was admitted approximately a week ago. He underwent a loop diverting colostomy as well as a Girdlestone procedure for a nonhealing chronic stage IV right ischial and trochanteric ulcers. He has been receiving negative pressure wound therapy dressing. His colostomy is working well and he presents today for definitive closure.....
Procedure in detail: This 34 y/o Caucasian male patient was brought to the operating room, placed in the supine position, and placed under general endotracheal anesthesia......We first curettage all of the wound and the granular tissue that had accumulated over this past week with negative pressure wound therapy and we cultured some of this curetted tissue. We then utilized 3000 ml bag of normal saling for pulse irrigation for adequate irrigation and minimal hemostasis was needed. We placed two 19-French Blake drains. They are placed out laterally and secured to the skin with 2-0 nylon. We undermined cutaneously on the gluteal muscle as well as the posterior thigh muscles and, at this point in time, we placed one drain in the acetabulum and down deep around the remnant of the femoral resection. We were able to approximate the deep layers of the posterior thigh muscles with figure-of-eight stitches of - Vicryl. The gluteal muscles were then reapproximated back over the trochanteric defect with 0 Vicryl simple stitches and then the deep dermis with 0 Vicryl, the superficial dermis 3-0 Vicryl, and then the skin with 2-0 Prolene in horizontal mattress fashion.....
I originally billed it as 15734-58, 15956-58-51, and 97606-58-59. I coded this one in the very beginning, when I first started coding for plastic surgery.
Ins paid the 15956 and 97606, denied the 15734 as not documented.
Now I'm thinking I probably should have used a code from the 14XXX series for the flap however, without a measurement indicated, would I have to use lowest sq cm?
Would greatly appreciate your input!
Thanks in advance!