katiejeanne
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I am in need of some help with 2 procedures within 3 days....
We have a patient who came in and had an I&D of an abscess/osteomyelitis of the 2nd metatarsal with removal of a little bone and the incision was left open to drain. The patient returned 3 days later to have the area debrided and then sutured closed. The surgery department wants to charge with CPT 28005 for the first procedure, then 20005 (I&D) and 13160 (late closure of wound) for the second procedure. I am supposed to approve of this and I am not sure this coding is appropriate and I don't want to overcharge the patient. Does anyone have any suggestions about this? Would a modifier -52 be needed on the first procedure? I've never had to code a situation like this...Thanks in advance for any help!!!
Summarized OP Report for procedure #1
Procedure: Incision and drainage of left 2nd MPJ.
....Two semi-elliptical incisions were placed over the ulceration on the plantar aspect of his left 2nd MPJ. The redundant skin and abscess tissue was all debrided and removed from the operating field. There was some purulent drainage noted. The bone did have some good viability, but there was some brownish discoloration plantarly, so at this time using the sagittal saw, the 2nd metatarsal head was then resected and excised from the operating field. The base of the proximal phalanx also appeared to have some discoloration so this was also resected at the base of the 2nd digit. The area was flushed with saline, retention sutures were then placed with 3-0 nylon and was packed with iodoform gauze packing....the plan is to do incision and drainage on Thursday afternoon to clean out the joint and possibly secondarily close the area.
Summarized OP Report for procedure #2, 3 days later
Procedure: Incision and drainage with secondary closure of the left foot.
....The retention sutures were removed and the area was debrided with a #15 blade and fibrous debris was removed. No purulent drainage was noted. Good granular tissue was noted already. The area was flushed with saline and cultures taken. The surgical site and incision was then reapproximated with 3-0 nylon in a simple interrupted-type fashion....
Katie
We have a patient who came in and had an I&D of an abscess/osteomyelitis of the 2nd metatarsal with removal of a little bone and the incision was left open to drain. The patient returned 3 days later to have the area debrided and then sutured closed. The surgery department wants to charge with CPT 28005 for the first procedure, then 20005 (I&D) and 13160 (late closure of wound) for the second procedure. I am supposed to approve of this and I am not sure this coding is appropriate and I don't want to overcharge the patient. Does anyone have any suggestions about this? Would a modifier -52 be needed on the first procedure? I've never had to code a situation like this...Thanks in advance for any help!!!
Summarized OP Report for procedure #1
Procedure: Incision and drainage of left 2nd MPJ.
....Two semi-elliptical incisions were placed over the ulceration on the plantar aspect of his left 2nd MPJ. The redundant skin and abscess tissue was all debrided and removed from the operating field. There was some purulent drainage noted. The bone did have some good viability, but there was some brownish discoloration plantarly, so at this time using the sagittal saw, the 2nd metatarsal head was then resected and excised from the operating field. The base of the proximal phalanx also appeared to have some discoloration so this was also resected at the base of the 2nd digit. The area was flushed with saline, retention sutures were then placed with 3-0 nylon and was packed with iodoform gauze packing....the plan is to do incision and drainage on Thursday afternoon to clean out the joint and possibly secondarily close the area.
Summarized OP Report for procedure #2, 3 days later
Procedure: Incision and drainage with secondary closure of the left foot.
....The retention sutures were removed and the area was debrided with a #15 blade and fibrous debris was removed. No purulent drainage was noted. Good granular tissue was noted already. The area was flushed with saline and cultures taken. The surgical site and incision was then reapproximated with 3-0 nylon in a simple interrupted-type fashion....
Katie
