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Posted By Dorine on 04-20-2021, 11:57:19 in Ob-Gyn
Hello Ob-Gyn group, Patient had a C/Section on 03/25/21 and returned to OR on 04/09/21 for Wound debridement and reapproximating of wound dehiscence in the setting of wound infection -surgery is as follows: Pfannenstiel incision was opened with blunt traction and sharp excision. Diffuse grey to brown friable tissue was noted underlying the entire incision line. Further debridement revealed a small fascial dehiscence over right aspect of the incision. This was opened to reveal additional necrotic tissue above the rectus abdominal muscles. Given tissue friability and degradation, presentation could be consistent with old, infected hematoma. The peritoneal cavity was not formally entered and there was no evidence of underlying fluid collection or necrosis when the midline was probed. Fascial edges were also found to be largely necrotic and non-viable tissue was sharply excised off the superior and inferior edges until health bleeding tissue was reached. Necrotic tissue was debrided. Bleeding points from debridement of the anterior aspect of the rectus muscle were addressed with Bovie, suture ligation, and arista. Once hemostasis was achieved, fascia was closed with 0-PDS. Subcutaneous tissue bleeding was addressed with Bovie. Once hemostasis was achieved and all visible necrotic tissue had been successfully debrided, wound was packed with wet gauze . ABD pad and pressure dressing were then applied. She then returns to OR on 04/12/21: General anesthesia obtained without difficulty. The patient prepped and draped in dorsal supine position in normal sterile fashion. Patient was prepped iodine. Friable tissues was excised and wound was irrigated. The previous incision was cut out to facilitate healing. Bovie electrosurgery was utilized on bleeding edges. Arista was used after final irrigation. Due to continued oozing from the incision, the decision was made to call wound care for the placement of a wound vacuum rather than closing the incision. Incision was measured to be 16 cm by 2 cm by 1 cm. Wound vac placed, see wound team notes for further detail. Instrument, sponge, and needle counts were correct prior the abdominal closure and at the conclusion of the case. The patient was taken to the recovery room in stable condition. My coding selection for the 1st surgery was 11005-78 and 13160-78 and for the 2nd surgery was thinking 11005-78 again, not sure if I have captured everything accurately. The path report says :Specimen Information: Caesarean Section Site; Wound
 Culture result
No anaerobes isolated.
Few Coagulase negative Staphylococcus Abnormal
Few Enterococcus faecalis Abnormal
Three colonies Serratia marcescens Abnormal
diphtheroids Abnormal
Susceptibility testing not done; isolates are kept for 7 days from the date a culture is final.
Would I use the O90.0 or T81.4XXA as primary coding? A41.53,A36.82,B95.2? Any help is greatly appreciated. Thank you so very much!

 



Comments (2)
Posted By Dorine on 04-26-2021, 13:29:34
Thank you for the confirmation of my codes Melanie, you are always appreciated! :)
Posted By Melanie Witt on 04-26-2021, 13:18:38
First, you must report O90.0 as your primary diagnosis for both surgical episodes as this is a result of pregnancy. You can additionally code for A and B code for the infective agents. Your suggested CPT coding is spot on for this case. The other group will code for the vac.
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