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Excision chronic wound sinus, I&D abd wall abscess, removal of foreign body

  1. #1
    Northeast Kansas AAPC
    Default Excision chronic wound sinus, I&D abd wall abscess, removal of foreign body
    Medical Coding Books
    Not quite sure about this one.

    Elliptical incision was made around the chronic draining wound area in the patient's abdomen. This was carried own into the subcutaneous tissue and down to the anterior abdominal wall fascia. There was a tract that tracked through the muscle to the peritoneum. This was taken down to the peritoneum and then divided. It appeared that the stomach was adherent under this area. By history this site had been a jejunostomy tube but the area was oversewn with 3-0 PDS suture. The muscle and fascia were then reclosed over the this area with an 0 PDS suture. I did not identify the foreign body at this site. The patient, more superior on the abdomen had a fluctuant area. I incised and drained this area and found a fluid collection here. This was cultured. In the base of this was a foreign body. This appeared like a radiologic T-fastener used sometimes in feeding tube placement. This was removed and passed as specimen along with the wound sinus. This area tracked down to the initial tube tract. The sinus site incision was then closed in layers with a deep layer of 2-0 Vicryl. We did partially approximate the skin but left partial areas open and did put a wick gauze down to the fascial level. The incision and drainage site superiorly was partially closed as well but the gauze wick was placed down to the base of this wound as well. A bulky gauze dressing was applied.

    Thanks for any input.

  2. #2
    Milwaukee WI
    Default Two incisions?
    I'm not sure I'm reading this correctly .... there were two separate incisions?

    I'm thinking 11005 for at least the first I&D where no foreign body was found.

    But I can't tell where the foreign body actually WAS, anatomically speaking ... in the skin layers, in the fascia, in the muscle, in the stomach, in the peritoneum? There is a code for removal of a foreign body from the peritoneum .. 49402 ... but this documentation doesn't really match the description of that procedure.

    At present, the best I can think of would be 11005 with a -22 modifier. But I think the better option is to get some clarification on this dictation from the physician, before coding it.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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