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I&D code help needed

  1. #1
    Columbus, Ohio
    Default I&D code help needed
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    Hello coders, I know this will sound stupid but here I go. The surgeon coded an I&D using 27603 and I think it should be 11043. Please check his op note to see if I'm missing something that indicates this was drainage and not debridement. I'm always hesitant to change a code he has chosen. Thanks, Paula

    1. Adjacent tissue transfer left lateral lower extremity wound with
    closure 12 x 2 cm, 14021.
    2. Left knee arthroscopy with synovectomy, 29876.
    3. Incision with debridement left lower extremity medial wound 30 x 10
    cm, 27603.
    4. Incision with debridement left lower extremity lateral wound 12 x 2
    cm, 27603.
    5. VAC placement left medial lower extremity wound 30 x 10 cm.

    The patient is a 50-year-old male who was seen previously at Doctors
    Hospital as a consultation. The patient, by history, had an abscess of
    his left lower extremity and had an incision and debridement by
    Podiatry. He is an end-stage renal patient. This did grow out
    bacteria. The patient's wounds were packed with wet-to-dry dressing
    changes by Podiatry. They were quite large wounds. There was question
    about a knee infection. The patient had pain with range of motion of
    his knee. There was an attempted aspiration by the orthopedic resident
    but there was no fluid that could be drained. An MRI was taken which
    showed a knee joint effusion. There was no abscess around the knee.
    The large lower extremity wounds had necrotic tissue that needed a
    repeat debridement. The decision was made to do an arthroscopy of the
    knee to rule out infection of the knee joint as well. Risks, benefits
    and complications were reviewed and appropriate consent was obtained.
    The patient agreed to proceed with the surgery.

    The patient was seen in preop holding by Departments of Orthopedics and
    Anesthesia at which time he identified the left lower extremity as the
    appropriate extremity for the procedure. I placed my initials on the
    extremity for identification. He was receiving IV antibiotics on the
    floor. He was taken back to the OR suite and placed supine on a
    well-padded table. Placed under general anesthesia without
    complication. A well-padded tourniquet was placed on the left upper
    thigh. The extremity was sterilely prepped and draped in normal
    The first part of the procedure was the arthroscopy. We covered up the
    lower extremity open wounds with sterile dressing and Esmarch bandage.
    This left the knee exposed only. We did not want to contaminate the
    knee. The standard inferomedial and inferolateral portals were created
    sharply with a knife through skin. Blunt trocar and cannula were placed
    in the inferolateral portal and suprapatellar pouch was entered. There
    was a significant amount of synovitis and erythema in the knee. Shaver
    was placed in the inferomedial portal and a synovectomy was completed in
    the suprapatellar pouch, medial and lateral compartments. Once this was
    completed, the articular cartilage could be seen. The patellofemoral
    joint was without any lesions. The medial and lateral gutters were
    entered. There was no abnormality. Femoral notch was inspected and the
    ACL and PCL were intact. The medial and lateral compartments were
    entered and the cartilage and meniscus looked good. There were no
    cartilage lesions or tears. There were no signs of infection at this
    point. The knee was washed out. The only thing that could be found was
    significant synovitis that was debrided. The instruments were
    withdrawn. Portals were closed with suture. A sterile dressing was
    placed around the knee.
    The lower extremity wounds then could be opened. The medial wound was
    very large. This was almost down to bone. This involved skin,
    superficial tissue, deep fascia and muscle. Necrotic skin was seen at
    the edges. The knife was used to debride off and excise all of the
    necrotic skin edges. The lateral wound did not look as bad. A knife
    was used to excise some of the necrotic skin there. The tissue looked
    much more viable. There was no gross pus. Curettes were used to
    debride both wounds. Copious amounts of pulse lavage irrigation was
    used to irrigate out both wounds. Once good healthy tissue could be
    seen, the lateral wound was undermined and adjacent tissue transfer
    could be done so that the incision could be closed.The skin edges were
    brought together with 2-0 Vicryl intradermally. Staples were placed on
    the skin. The medial wound could not be closed. Wound VAC sponges were
    placed in the wound and then a wound VAC was applied to suction. The
    patient did have a plantar ulcer which was not very deep which was being
    handled by Podiatry. Wet-to-dry dressing changes were placed on this.
    An Ace bandage was then placed from the foot up to the thigh. The
    patient was then awoke from anesthesia without complication and
    transferred to post anesthesia care in stable condition.

    The patient did not have an infection of his knee. He did have
    significant synovitis. This was debrided out. His lateral wound was
    able to be closed. This was without much tension. Adjacent tissue
    transfer was completed on this with the closure. A wound VAC had to be
    used on the medial side. The lateral wound measured 12 x 2 cm. The
    medial wound measured 30 x 10 cm. The medial wound was quite large. I
    did get a good debridement. The wound VAC will be used and changed
    every 3 days until the wound has healed. The patient is an end-stage
    renal patient and his prognosis is somewhat guarded. He will continue
    IV antibiotics per Infectious Disease.

  2. #2
    Thumbs up Debridment
    I didn't see anything that indicated a drainage. the only mention was in the previous history, not the procedure itself.
    I will have to agree with you, that 11043 is the more accurate code, because any drainage that was done was not documented.

    Gwynn Seewald
    Blanco, Tx

  3. #3
    Columbus, Ohio
    Gwynn, thanks so much, I thought I was missing something because this surgeon is usually good when he does give me a code. Paula

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