Inpatient procedure with ICD code

cpccoder2008

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I'm looking for an ICD procedure code for the following procedures. I am having a dispute with one of my co workers about what code to use and would like a second opinion. I will post several op reports on different threads that way its not all together. Thanks

OPERATIONS: Left elbow I and D.

COMPLICATIONS: None.

INDICATION FOR PROCEDURE: Mr. ___ is a 51-year-old gentleman who underwent an open reduction and internal fixation of left olecranon as well as his radial head; however, his postoperative course was complicated by poor wound care resulting in a wound dehiscence to undergoing multiple irrigation and debridement.

PROCEDURE IN DETAIL: After the appropriate consents were signed and the patient was marked. He was brought to the operating room and placed in supine position where general endotracheal anesthesia was applied by the Anesthesia Team. The left upper extremity was then prepped and draped free in the usual sterile fashion and we first turned our attention to the wound. The wound was copiously irrigated with 6 mL of normal saline. The wound was then closed. It was felt that the wound would be able to be closed with 2-0 nylon, this done in a horizontal mattress type manner. Sterile dressing as well as an incisional wound VAC was placed. The patient was allowed to recover from anesthesia and taken to recovery.
 
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cpccoder2008

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OPERATIONS: Left elbow wound VAC change and irrigation and debridement.

COMPLICATIONS: None.

ANESTHESIA: LMA.

INDICATIONS: Mr. ___ is a 51-year-old gentleman who is status post open reduction internal fixation of his left radial head and olecranon. He presented to the clinic over the wound dehiscence. He had been soaking his wound in water and nonsterile water for several days and formal irrigation and debridement and placement of wound VAC. The placement of wound VAC was performed on May 22, 2012.

PROCEDURE IN DETAIL: After appropriate consents were signed, the patient was marked and brought to operating room, placed in supine position with general endotracheal anesthesia was applied by the anesthesia team. The left upper extremity was then prepped and draped in the usual sterile fashion. The previous wound VAC was removed and the wound was copiously irrigated with 6 liters of normal saline. A wound VAC change was performed and the superior and inferior aspects of wound were closed with 2-0 nylon. A sterile dressing was applied and patient was allowed to recovery and taken to the recovery room in stable condition.
 

cpccoder2008

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OPERATIONS: Irrigation and debridement, left elbow.

ESTIMATED BLOOD LOSS: Less than 30 mL.

FLUIDS: Per anesthesia record.

ANESTHESIA: General.

OPERATIVE INDICATIONS: Mr. ___ is a 51-year-old male who underwent open reduction and internal fixation of his left elbow two to three weeks previously. He had been seen in clinic and had a small area of wound, which was partially opened with some purulent material. He was instructed to begin hydrogen peroxide cleanings and was seen back a week later for wound check. At that time, the wound was fully opened. There was significant amount of purulent material and the patient stated that he had been soaking the arm in water with some diluted soap. There was significant amount of laceration around the edges of the wound. Options were discussed and the patient was consented and brought to the OR for irrigation and debridement.

PROCEDURE IN DETAIL: After informed consent was obtained, the patient was taken to the operating room. General anesthesia was induced. The left arm was outstretched on a well padded hand table. The left arm was then prepped and draped in the usual sterile manner. After timeout was performed, the previous sutures were removed and the wound was opened. There was a fair amount of purulent material. Cultures were taken and 6L were irrigated through the wound using a Pulsavac. The bone was exposed. There was no necrotic material to debride following a full irrigation and removal of several Vicryl sutures from the deep layer. A black wound VAC sponge was placed in the wound and connected to wound VAC machine. The patient was then awakened, extubated, and taken to recovery room in stable condition, where he will be admitted for IV antibiotics.
 

cpccoder2008

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I came up with 96.59 (Irrigation) and 93.59 (wound vac). Can you explain to me why you would use a non excisional debridement ?
Thanks
 

kevbshields

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According to Coding Clinic, 3rd Quarter 2006, coders should not assign a code for wound VAC, as it is considered part of the closure, therefore inherent to the surgical service.

If you read 1st Quarter 2009 Coding Clinic, it leads me to believe 86.04 is most appropriate, as there was no debridement, simply incision and drainage. For the case of exposure to the bone, 77.13, as this is described as "incision INTO bone without division of site" and includes reopening of an osteotomy site.
 

cpccoder2008

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We were told my our coding supervison if all that was done was a wound vac change to pick up 93.59 which is why i coded it along with the irrigation code since all they did was rinse out the wound with saline and change the wound VAC. I agree with the 77.13 for the third procedure but i guess i'm getting confused with 86.28 (nonexcisional debridement) vs 96.59 (irrigation) ... what is the difference between the two ? I keep reading the op report over and over and i keep coming up with 96.59. The first report states The wound was copiously irrigated with 6 mL of normal saline. and the second report states The previous wound VAC was removed and the wound was copiously irrigated with 6 liters of normal saline
 
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