l1ttle_0ne
Guru
Can someone please help with codes for this. I was thinking 10061 for the abscess drainage. But not sure about the foreign body. Any suggestions?
PREOPERATIVE DIAGNOSIS: Two abdominal wall abscesses/fistulae.
POSTOPERATIVE DIAGNOSIS: Two abdominal wall abscesses/fistulae.
PROCEDURE: Exploration of two abdominal wall fistulae with drainage of abscesses and removal of mesh and sutures (foreign bodies).
INDICATIONS: This is an 85-year-old woman with a long and complicated surgical history who now has two pus draining fistulae of the upper abdominal wall. I suspected that there were underlying abdominal wall abscesses related to foreign bodies.
DESCRIPTION OF THE PROCEDURE: The patient was taken to the operating room and placed supine on the operating table. General anesthesia was induced. The abdomen was prepped and draped. Both of these fistulae were explored by enlarging the skin opening and following the tract down into deep abscess cavities. The abscesses were drained. In the case of the upper fistula, there was a piece of bunched up polypropylene mesh. This was completely removed. There was a resultant 2-cm fascial defect which was closed with interrupted 0 Vicryl sutures. In the case of the lower fistula, there was just a suture, probably Ethibond suture. This suture was removed. There did not appear to be a critical fascial defect associated with the lower abscess. Both wounds were packed with dry gauze, covered by dry gauze dressings. The patient tolerated the procedure well. There were no evident complications.