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Debridement Dilema...

  1. Red face Debridement Dilema...
    Medical Coding Books
    Need help. Any thoughts here would be appreciated. Patient had multiple non-healing wounds from a pressure washer injury to his right hand. Patient was wearing gloves at the time and the material removed came from the gloves.

    ....Esmarch was used to exsanguinate the right upper extremity. Tourniquet was set at 200 mmHg. Attention was first drawn to the base of the thumb. There was an incision which was slightly debrided. This therefore displayed the thenar space. This was irrigated copiously with antibiotic irrigation, as well as Betadine. After proper treatment of the thenar space, attention was then directed to the palm. There was also a non-healing wound there. The wound was gently debrided and multiple pieces of greenish-blue material were removed from this area. This along with the thenar area had the edges freshened up using a #15 scalpel. Next, attention was directed to the fifth, fourth, third, and second digits. On the volar aspect of all of these digits there were non-healing wounds. Greenish-blue material which was previously seen was removed from all of these areas. Copious amount of irrigation was done, as well as gentle debridement. Pulse lavage was also used with antibiotic irrigation to improve the debridement. Cultures were sent. Numerous digits that were explored displayed wide open flexor tendons upon the minimal debridement which was present. Therefore gentle closure using 5-0 Monocryl was done to help protect these tendons. The size of the repairs of the suture lines were as follows: Second digit was 0.4 cm, third digit was 2.0 cm, fourth digit was 20. cm, fifth digit was 2.5 cm, palmar suture line was 2.4 cm, and the base of the thumb was 4.0 cm.......

    I want 11042 but he doesn't describe the tool he uised to do the debridement (which I understand is necessary now to use that code?).... 26010 or 26011??? But then do you also code the closure? I'm coding for the facility fee in an ASC.

    Thanks to anyone who can help.

  2. Default
    After reading your dilemna, I would have to agree with you on code 11042 but I would also use the repair code 12005. I do not agree with codes 26010 or 26011 because those are incisional drainage codes.

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