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Thread: i&d of fasciitis

  1. #1
    Join Date
    Apr 2007
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    Default i&d of fasciitis

    Promo: Code Books
    would this fall under 27603?


    On the day of surgery he was brought into the operating room and placed in the supine position on the operating table. At the induction of endotracheal anesthesia the patient was very unstable with hypotension which responded to pressors and his heart rate went up to the 170s. Surgery was delayed until the patient was stabilized. Once he was stabilized the left leg was prepped and draped in the usual fashion. The point of maximal fluctuance on the lateral distal thigh was addressed first. This was widely anesthetized with 0.5% Marcaine with epinephrine. Incision made with electrocautery. A pocket of clear fluid was entered. There was copious drainage. A gloved finger was used to extend the super fascial dissection proximally and distally and the skin was opened to the greatest extent of the pocket of clear fluid. He continued to weep serous fluid from this area. There was no pus. A culture was performed. An incision was made midway up the thigh laterally on the left side. This had some fluid but did not have extensive tracking. Similarly another incision was made higher up on the level of the hip. This had some pocket of clear fluid but there was not extensive tracking. Another incision was made in the left flank because on the CT scan it looked like some dependent fluid laterally. This pocket was entered but there was not extensive tracking. The distal medial thigh was then addressed. There was an area of maximal fluctuance and this was widely anesthetized. Incision made with electrocautery and there was a small fluid collection entered. Again this was a serous collection. The tissue continued to weep in this area but there was no pus and there was no compromise of muscle and there was no evidence of gas. Finally the left lateral calf was addressed. It was not so worrisome earlier in the day but this evening it looked a little worse. It similarly was anesthetized with Marcaine with epinephrine. Incision was made with electrocautery. Similarly a pocket was entered. The incision was extended superiorly and inferiorly along the fascia. There was no evidence of gas or gangrene. The muscle and the fascia were viable. Bleeding was controlled with electrocautery. All the incisions were then generously irrigated with a total of two liters of normal saline. Bleeding was controlled with electrocautery. All the wounds were dressed with two-inch Kerlix roll as wet-to-dry packing. He was stabilized. He was left intubated and brought to the ICU in guarded condition.

    thanks for any help

  2. #2

    Default

    I will suggest this as 'cellulitis' of most of the areas incised.
    TheCPT code merits to this scenerio is 10061..
    10061 I & D of abscess (cutaneous or subcutaneous ) with modifier -22 for extensive/extension work on to the flanks incision and drainage (no fliud, though), supported with the ICD-diagnosis 682.2 - Other cellulitis and abscess Trunk ( flank).
    Modifier for laterality also include- ie, LT to the CPT code
    Andfor Leg - ICD-9 CM - 682.6 Cellulitis and abscess of leg.
    So CPT: 10061- 22 LT,
    ICD-9: 682.6, 682.2

  3. #3

    Default

    Query your Physician "cellulitis" and "fascitis" are different.

    You need to know the tissue layer the "fluid pockets" are located. The edited version is not clear; if the complete documentation is not different. Your physician will need to addend the report to clarify. Otherwise you will need to go with the skin codes.

    If you go with the skin codes it seems 10140 would be more appropriate as 10140 specifies "fluid collection".

    Typically:
    Epidermis, dermis and subcutaneous tissue use: integumentary codes (10000-19499)
    Fascia, muscle, tendon and bone use: musculoskeletal codes 20005-29999.

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