Question

1. Adjacent tissue transfer and surgical rearrangement to left leg defect, estimating it to be 15–16 sq. cm.
2. Surgical preparation and creation of recipient site by excision of deep necrotic open wound with considerable eschar and scar tissue, skin, subcutaneous tissue, fascia, muscle, and down to bone.

Diagnosis: Open necrotic ulcer of the leg, 16 sq. cm. in size, extending through full-thickness skin, subcutaneous tissue, fascia, muscle, and down to bone.

Indications: The patient was referred from ___ [PLACE] with a complicated leg injury with subsequent development of deep necrotic ulcer, which had been getting worse over time. The injury happened nearly 1 month ago from a crush injury involving the left lower extremity. From the time of the original injury until now, the necrosis appears to be mostly due to extensive crush injury involving the tissue. There is no exudate and no signs of infection.

Operation in Detail: After sterile preparation and draping in the normal sterile fashion, and local anesthetic, using a 15-blade scalpel and iris scissors, the wound was debrided of devitalized and necrotic tissue until healthy tissue with adequate bleeding was achieved. This involved excision of skin, subcutaneous tissue, fascia, and muscle, and at the deepest margins the tissue was extremely crushed and devitalized and mostly due to this, as evident by the nature of the injury and the tissue involved.

After 25 minutes was spent doing extensive debridement, the wound was irrigated with antibiotic saline solution. Since there was bone exposed, covering the wound was necessary.

On preoperative evaluation, the patient did have a possible dorsalis pedis and posterior tibial pulse. He did have swelling in the area. He had been worked up for diabetes at ___ [PLACE] and all his workup turned out to be negative.

The patient states he has never smoked more than a couple of cigarettes a day and states that for 10–15 years he has smoked 2 cigarettes a day.

The decision was made for local tissue rearrangement with a rotation advancement flap. It was based proximally on a more robust blood supply. An incision was made with a scalpel, including the fascia; hence, a fascia-cutaneous rotation advancement flap was developed superiorly based on a fairly robust pedicle, including the fascial components. This allowed fascial advancement. The fascia was released proximally, in order to allow further advancement so that the fascia was advanced and would cover the exposed bone defect. The subcutaneous and fascia layers were reapproximated using 4-0 PDS sutures, hence, placing no significant tension on the skin closure. The skin was closed using 4-0 PDS suture. Some undermining was done in order to take further tension off of the closure. The patient tolerated the procedure well. No complications occurred throughout. The patient understands the importance of elevating the leg to prevent swelling. There is a possibility of future development of a newer ulcer or flap necrosis and development of an ulcer, which would result in more conservative treatment.

The patient apparently had adequate blood supply to the flap throughout the procedure. Post procedure the patient also had good normal pinprick bleeding and good capillary refill to the distal end of the flap. The patient was given distinct postoperative instructions and will follow up back in my office for re-evaluation and suture removal in 2–3 weeks. He will follow up next week if there are any problems or concerns with the flap, which were discussed in detail.

Estimated blood loss was less than 50 cc.

1. FILL IN THE BLANK.
   Enter the proper code(s) in the blank(s) provided. If a specific category of code is not applicable please leave the box blank. When entering multiple codes in the same box separate them with a comma and a space (i.e. E11.9, I10).
   1. Primary ICD-10-CM Code:
   2. Secondary ICD-10-CM Code(s):
   3. Z Code(s):
   4. External Cause of Morbidity Code(s):
   5. Primary CPT Code:
   6. Secondary CPT Code(s):
   7. HCPCS Code(s):

Answer 1

Answer :

Open necrotic ulcer of the leg :

Primary ICD 10 CM CODE : L07. 909.

Secondary ICD 10 CM CODE : L97.921, L97. 503.

Zcodes : debridement of necrotic tissue of ulcers is" Z 48.817"

Primary CPT CODE : 97597, 97598,

Secondary codes : 11042 -11047.