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new coder needs help with CPT for I&D of buttock abscess

  1. #1
    Default new coder needs help with CPT for I&D of buttock abscess
    Medical Coding Books
    Need others opinions on this op note. Thank you.

    The perineum, scrotum and the perirectal area were prepped and draped in standard sterile surgical fashion. The open wound on the left medial buttock was examined and found to be only 3 cm from the anal verge. Digital rectal examination did not reveal any internal masses or induration. The necrotic skin edges around the open wound were sharply debrided and the abscess cavity was palpated and found to extend superiorly and medially into the perineum. The wound was extended superiorly along the tract and a large amount of a foul-smelling purulent exudate was drained. This was also swabbed for aerobic and anaerobic cultures. After full debridemrent of the necrotic tissue in the perineum and buttock, the entire wound cavity was irrigated with a Pulsavac irrigation unit with a total of 4 liters of sterile fluid. One bleeding vessel within the perineal soft tissue was controlled with two figure-of-eight sutures of 3-0 silk. The wound cavity was packed with Kerlix soaked in Betadine and voered with an ABO pad.

  2. Default
    I would look at 46050

  3. #3
    Thanks for your help.

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