AR2728
Expert
Here's the op report we are struggling to code appropriately. One coder suggested 24076 another 20240---not really sure where to go with this procedure. Help with the CPT would be very much appreciated!
The left arm was placed in elevation, tourniquet inflated 250 mm of Mercury.
Incision was made along the prior incision line, lifting out the dehisced skin proximally.
Soft tissue was performed creating deep flaps medially and laterally. There was abundant
soft tissue present. The patient did have what appeared to be a sinus extending towards
the skin. There was no obvious purulence, however there was gelatinous type material
which gram stain and cultures were taken. The sinus was ellipsed out at this point in
time. The patient appeared to have the sinus going towards the bone. Gram stain and
cultures were taken of the deep soft tissue as well as a bone specimen was sent to
Pathology and bone sent for gram stain and culture as well. After the wound was
copiously debrided with a curette, 9 liters of Crystalloid with Bacitracin was pulseevaced
washing out the wound. At this point in time the tourniquet was down. There
was no significant bleeding. The patient did have a small rent in the triceps. Due to the
history of infection, no repair was made at this point in time due to the fact that bacteria
could cling to the suture. At this point in time, the wound was closed with #0 Proline
suture. Sterile soft dressing of Xeroform, 4X4's, ABD's, and a long arm posterior splint
was placed in extension on the left arm was done
The left arm was placed in elevation, tourniquet inflated 250 mm of Mercury.
Incision was made along the prior incision line, lifting out the dehisced skin proximally.
Soft tissue was performed creating deep flaps medially and laterally. There was abundant
soft tissue present. The patient did have what appeared to be a sinus extending towards
the skin. There was no obvious purulence, however there was gelatinous type material
which gram stain and cultures were taken. The sinus was ellipsed out at this point in
time. The patient appeared to have the sinus going towards the bone. Gram stain and
cultures were taken of the deep soft tissue as well as a bone specimen was sent to
Pathology and bone sent for gram stain and culture as well. After the wound was
copiously debrided with a curette, 9 liters of Crystalloid with Bacitracin was pulseevaced
washing out the wound. At this point in time the tourniquet was down. There
was no significant bleeding. The patient did have a small rent in the triceps. Due to the
history of infection, no repair was made at this point in time due to the fact that bacteria
could cling to the suture. At this point in time, the wound was closed with #0 Proline
suture. Sterile soft dressing of Xeroform, 4X4's, ABD's, and a long arm posterior splint
was placed in extension on the left arm was done