3rd Request Foreign body not found-only excision of scar tissue
It appears there was no foreign body found and that excision of deep callus and scar tissue was only done. The surgeon has billed 28192. I don't think this is correct but cannot find a code for what was done.
Indications: This is a 27-year-old female stepped on a piece of glass on January 21, 2017. X-rays were negative for the presence of a foreign body on the day of her injury but she has continued to have worsening pain on the plantar aspect of her foot with every step. A CT scan from 03/30/2018 showed an area of increased density in the subcutaneous fat on the plantar aspect of her foot that corresponded with point of maximum tenderness. She has failed to get adequate relief with activity and shoe wear modification and has elected to undergo surgical intervention to remove the foreign body and surrounding scar tissue.
Procedure: A longitudinal incision was made on the plantar aspect of her foot using her previous traumatic wound. There was a large thick deep callus extending through the dermis down to the subcutaneous tissue and this was sharply excised. There was extensive scar tissue in the subcutaneous tissue corresponding to the area of concern on the CT scan and where she was post painful. This was all thoroughly excised sharply. The wound was probed digitally and visually and there was no remaining dense scar tissue. There were no other foreign body object noted.
The wound was copiously irrigated with antibiotic laden normal saline and the subcutaneous layer closed with 3.0 Vicryl suture and the skin closed with 3.0 nylon suture. A sterile dressing was applied and a soft dressing applied to the foot.
Any help is greatly appreciated as always!