Suture Protruding in OD/ Post Corneal Graft x7 years ago

hduncan

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Renton, WA
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Hello everyone,
I need some help on this one. A patient was seen in one of our clinics today that was referred over to us from an urgent care. They had opened a L&I suspecting it was a work injury. Turns out the patient had a corneal graft done 7 years ago for Keratoconus and now has a stitch that is protruding. My understanding is the stitches can stay in for quite some time, however, this is 7 years ago. I'm not sure what the correct ICD-10 code would be in this situation.
Anyone willing to help me out?
Thank you in advance!!
 
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Quezon City, MM
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this is what I come up

try using T85.692A - Other mechanical complication of permanent sutures, initial encounter

suture, permanent (wire) NEC T85.9
-with repair of bone - see Complication, fixation device, internal
-embolism T85.81
-fibrosis T85.82
-hemorrhage T85.83
-infection and inflammation T85.79
-mechanical
-breakdown T85.612
-displacement T85.622
-malfunction T85.612
-malposition T85.622
-obstruction T85.692
-perforation T85.692
-protrusion T85.692
-specified NEC T85.692

plus Y77.3- Surgical instruments, materials and ophthalmic devices (including sutures) associated with adverse incidents
 

hduncan

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try using T85.692A - Other mechanical complication of permanent sutures, initial encounter

suture, permanent (wire) NEC T85.9
-with repair of bone - see Complication, fixation device, internal
-embolism T85.81
-fibrosis T85.82
-hemorrhage T85.83
-infection and inflammation T85.79
-mechanical
-breakdown T85.612
-displacement T85.622
-malfunction T85.612
-malposition T85.622
-obstruction T85.692
-perforation T85.692
-protrusion T85.692
-specified NEC T85.692

plus Y77.3- Surgical instruments, materials and ophthalmic devices (including sutures) associated with adverse incidents

Thank you so much for your prompt response! I was unsure about the sutures, still throws me off that they would be left indefinitely. I do appreciate your help.
 

mitchellde

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I believe the T85.692- code is incorrect. These are not permanent sutures. Even if the patient failed to return to have them removed, the intent of the provider was not they would remain, the intent was that these would be removed. Permanent sutures are usually a non soluble type of material, usually a wire that are inserted with the inten that they will never be removed. I would use a surgical complication code.
 

hduncan

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Thank you for your input, I'm having a quick telemeeting with the doctor to get more information. I have no chart notes at this point, until I have those to look at I won't code and bill. ;)
 
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Quezon City, MM
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Non-absorbable sutures

I believe the T85.692- code is incorrect. These are not permanent sutures. Even if the patient failed to return to have them removed, the intent of the provider was not they would remain, the intent was that these would be removed. Permanent sutures are usually a non soluble type of material, usually a wire that are inserted with the inten that they will never be removed. I would use a surgical complication code.
Permanent suture is only a term, it means non-absorbable suture, it is use for wounds that needs longer time to heal, it does not mean that it won't be remove, example of this is using permanent sutures to hold drains . Permanent sutures are stitches that will not be dissolved by the body. They either stay in place forever or have to be removed by the surgeon.

sites that states the uses of permanent suture:
https://www.realself.com/question/permanent-visible-sutures-for-tummy-tuck#gref
https://www.realself.com/question/otoplasty-dissolvable-permanent-sutures#gref
http://www.tavmd.com/2013/06/19/plastic-surgery-stitches-suture-information/
http://www.woundcarecenters.org/article/wound-therapies/sutures-stitches-and-staples

There may be some practices that use a permanent suture, but that should be removed when the incision has sufficiently healed (typically 5-7 days).- Steven H. Williams M.D. (Plastic Surgeon)
 
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