Barbiejean
Contributor
Good morning...
I could use some help with the following op note. We've coded it out to 11043 x1 & 11046 x45.
Pt has bilateral necrotizing faciititis on the bilateral neck spaces down to the muscle.
Op note reads as follows:
Given the concerns on physical exam and imaging, an apron incision was made extending from approximately the mastoid tip on the right along the anterior border of the sternocleidomastoid across the midline at the level of the cricoid to the contralateral sternocleidomastoid and then back up to the contralateral mastoid on initial and this incorporated her previous I & D drain, which was removed. On initial incision, there were copious amounts of discolored dishwater material. Tissue culture was sent from the platysma which was completely necrotic and nonviable, and the entire platysma muscle was debrided. The above findings were noted and extensive debridement was performed using Metzenbaum scissors, curet, scalpel and bovie debridement. This included the above muscles, the above square centimeters tissue. Necrotic tissue was debrided back to bleeding tissue and viable tissue and the wound was subsequently irrigated with copious amounts of antibiotic solution. The hemostasis was achieved with Bovie. A wound VAC was applied and she was subsequently transferred to the ICU.
Procedure performed: Incision and drainage and debridement of bilateral neck spaces:
A - extensive debridement of bilateral platysma muscle, 30 x 30 cm using sharp incision, a combination of curette, 15 blade and Metzenbaum scissors
B - Debridement of bilateral sternocleidomastoid muscles anterior surface right and left, each approximately 10 x 5 cm, sharp technique as above
C - Extensive debridement of the central compartment superficial strap muscles and partial eval of pretracheal neck space - approximately 5 x 8 cm, same technique as above
The major issue here is that there is a MUE of 10 for 11406 which would only account for a small portion of what he did. I have looked for any other codes that could be used that have "higher than 20 sq - or am I misreading it.
Any help is greatly appreciated
I could use some help with the following op note. We've coded it out to 11043 x1 & 11046 x45.
Pt has bilateral necrotizing faciititis on the bilateral neck spaces down to the muscle.
Op note reads as follows:
Given the concerns on physical exam and imaging, an apron incision was made extending from approximately the mastoid tip on the right along the anterior border of the sternocleidomastoid across the midline at the level of the cricoid to the contralateral sternocleidomastoid and then back up to the contralateral mastoid on initial and this incorporated her previous I & D drain, which was removed. On initial incision, there were copious amounts of discolored dishwater material. Tissue culture was sent from the platysma which was completely necrotic and nonviable, and the entire platysma muscle was debrided. The above findings were noted and extensive debridement was performed using Metzenbaum scissors, curet, scalpel and bovie debridement. This included the above muscles, the above square centimeters tissue. Necrotic tissue was debrided back to bleeding tissue and viable tissue and the wound was subsequently irrigated with copious amounts of antibiotic solution. The hemostasis was achieved with Bovie. A wound VAC was applied and she was subsequently transferred to the ICU.
Procedure performed: Incision and drainage and debridement of bilateral neck spaces:
A - extensive debridement of bilateral platysma muscle, 30 x 30 cm using sharp incision, a combination of curette, 15 blade and Metzenbaum scissors
B - Debridement of bilateral sternocleidomastoid muscles anterior surface right and left, each approximately 10 x 5 cm, sharp technique as above
C - Extensive debridement of the central compartment superficial strap muscles and partial eval of pretracheal neck space - approximately 5 x 8 cm, same technique as above
| 11043 | Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less |
| 11046 | Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) |
The major issue here is that there is a MUE of 10 for 11406 which would only account for a small portion of what he did. I have looked for any other codes that could be used that have "higher than 20 sq - or am I misreading it.
Any help is greatly appreciated