SavCoder
Contributor
When a patient is taken to the OR for wound dehiscence closure and during the surgery the provider does more than just secondary wound closure, can the additional work be reported in addition to 13160?
Preoperative Dx:
1. Left total knee arthroplasty, persistent drainage, concerning for infection
2. Left knee wound dehiscence
Postoperative Dx:
Same
Operation:
1. Delayed primary closure, left knee wound dehiscence.
2. Left knee irrigation and debridement with extensive synovectomy.
Indications:
The patient is a 71 year old male who complains a left knee persistent drainage with a small wound dehiscence since mid June. He previously underwent left knee replacement surgery in June.
Description of Operation:
Intraoperative aspiration was performed and 15 mL of clear amber colored fluid was sent to Pathology for analysis. A longitude incision was made through the previous midline patellar incision. The skin and subcutaneous tissue were sharply incised. Hemostasis was obtained with Bovie electrocautery. A smaller area wound dehiscence (1 x 2 mm) at the superior incision was sharply excised with a scalpel. blunt dissection was performed down to the quadriceps, patella and patellar tendon. the incision was then carried proximally to the quadriceps through the quadriceps, medial patellar tendon and medial tibial tubercle. The patella was subluxed laterally. Examination of the joint demonstrated generally clear fluid. using rongeurs, a synovectomy was performed. The wound was frequently irrigated with pulse lavage containing gentamicin with normal saline. The wound was then thoroughly irrigated with bacitracin, alcohol and normal saline with gentamicin. The knee was put through range of motion and demonstrated stability. A Hemovac drain was placed exiting superolaterally. The deep fascial and quadriceps were reapproximated using #1 PDS suture. The subcutaneous tissues were closed with 0 and 2-0 PDS Vicryl sutures. The skin was closed with 2-0 nylon vertical mattress sutures. The drainage site was reapproximated using 2-0 and 3-0 vertical mattress sutures. The inicision was dressed with a prevena VAC and overwrapped with an Ace wrap. The patient was placed in a knee immobilizer. The tourniquet was deflated for a total tourniquet tiem of 107 minutes. The patient was awakened in the operating room and taken to recovery room in stable condition.
The provider is suggesting CPT code 27301 (I&D deep abscess, bursa, or hematoma thigh or knee region.
When I code this op note I come up with 13160 (for the wound dehiscence closure) and 27334 (arthrotomy with synovectomy). But would the synovectomy be included in the would dehiscence closure?
Any thoughts on this is greatly appreciated!
Thank you
Preoperative Dx:
1. Left total knee arthroplasty, persistent drainage, concerning for infection
2. Left knee wound dehiscence
Postoperative Dx:
Same
Operation:
1. Delayed primary closure, left knee wound dehiscence.
2. Left knee irrigation and debridement with extensive synovectomy.
Indications:
The patient is a 71 year old male who complains a left knee persistent drainage with a small wound dehiscence since mid June. He previously underwent left knee replacement surgery in June.
Description of Operation:
Intraoperative aspiration was performed and 15 mL of clear amber colored fluid was sent to Pathology for analysis. A longitude incision was made through the previous midline patellar incision. The skin and subcutaneous tissue were sharply incised. Hemostasis was obtained with Bovie electrocautery. A smaller area wound dehiscence (1 x 2 mm) at the superior incision was sharply excised with a scalpel. blunt dissection was performed down to the quadriceps, patella and patellar tendon. the incision was then carried proximally to the quadriceps through the quadriceps, medial patellar tendon and medial tibial tubercle. The patella was subluxed laterally. Examination of the joint demonstrated generally clear fluid. using rongeurs, a synovectomy was performed. The wound was frequently irrigated with pulse lavage containing gentamicin with normal saline. The wound was then thoroughly irrigated with bacitracin, alcohol and normal saline with gentamicin. The knee was put through range of motion and demonstrated stability. A Hemovac drain was placed exiting superolaterally. The deep fascial and quadriceps were reapproximated using #1 PDS suture. The subcutaneous tissues were closed with 0 and 2-0 PDS Vicryl sutures. The skin was closed with 2-0 nylon vertical mattress sutures. The drainage site was reapproximated using 2-0 and 3-0 vertical mattress sutures. The inicision was dressed with a prevena VAC and overwrapped with an Ace wrap. The patient was placed in a knee immobilizer. The tourniquet was deflated for a total tourniquet tiem of 107 minutes. The patient was awakened in the operating room and taken to recovery room in stable condition.
The provider is suggesting CPT code 27301 (I&D deep abscess, bursa, or hematoma thigh or knee region.
When I code this op note I come up with 13160 (for the wound dehiscence closure) and 27334 (arthrotomy with synovectomy). But would the synovectomy be included in the would dehiscence closure?
Any thoughts on this is greatly appreciated!
Thank you