Wiki Thoughts on use of 21627 in this case

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LLovett

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PROCEDURE: After the patient gave informed consent, she was
brought to the operating room and placed under general
endotracheal anesthesia. The central aspect of her sternal
incision was reopened for a length of about 4 centimeters. The
wound was cultured. The incision lead down onto a sternal wire
which was cut and removed. Although the sternum was stable in
vicinity, the bone was soft and osteoporotic. The wound was
irrigated with antibiotic containing saline. It was then packed
with antibiotic soaked sponge and covered with a dry sponges.
Because of the poor quality of the bone, it is uncertain whether
this will ultimately heal with conservative measures. If not,
then a formal sternal debridement may be required to achieve
ultimate healing of this location.

15 days later they had to take the patient back in and do what he is calling a "formal debridement". I am ok with the 21627 for the 2nd trip, I am leary of it this time though.

Thanks

Laura, CPC, CEMC
 
The CT Coding Companion states for 21627 that "The sternum is debrided as warranted using any of a variety of hand or powered surgical instruments. Irrigation is used so that debridement can be completed as extensively as indicated." I interpret this to mean this code would be appropriate for more than one level of debridement.

I actually think this code would be ok to use this time. I wish the surgeon hadn't written "a formal sternal debridement may be required," I feel like it would have been better if he said "a more extensive debridement may be required," but I still think you can argue that this is a debridement regardless of how minor it may have been.

Lisi, CPC
 
For the 1st return to the OR (code 20680 -Removal of implant; deep) could be used for the Sternal wire removal and then 21627 for the Sternal Debridement or 21750 if it was Debridement and Closure.
 
20680

Personally, I'm up in the air about using 20680. This is what the STS has said about this code on their website -

"... In addition, code 20680 should not be reported separately for any type of thoracic re-do procedure where the sternal wires are removed as this is considered part of the procedure. For those cases where code 20680 may be reported, you should only report the code once regardless of the number of wires removed."

This case may be different because its not a re-do procedure but I just wanted to mention it.

Lisi
 
Hi All,

My physician has done CPT 21627 and 20680 and the Medical reports states that the patient was underwent the below procedures

1617099092906.png
CCI edit shows conflict for both CPT and can never be reported together.
somebody please help to bill this.
Thanks in advance!!!
 
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