Retained gallstone with abscess

pscheiderichpscheiderich
in Clinical & Coding

Patient presented with RUQ abdominal pain.  Had history of a Lap cholecystectomy 14 years ago.  Found to have an abscess with what looked like a gallstone in the abdominal wall.  An I&D of the abscess was performed with removal of the retained gallstone from subcutaneous tissue. 

What would be the principal diagnosis; the retained gallstone (K91.86) or the abdominal wall abscess (L02.211)?

Appreciate thoughts/suggestions!

Comments

  • pscheiderichpscheiderich

    I'm reposting to see if anyone feels I have a choice for principal diagnosis. 

    Thank you!

  • afrady@blr.comafrady@blr.com
    Was their a residual gall bladder or was it actually just a stone trapped within subcutaneous tissue?  K91.86 indicates there was a residual gall bladder.
  • pscheiderichpscheiderich

    No, the physician refers to it as a retained gallstone within subcutaneous tissue which led to the abscess. I interrupt K91.86 as retained gallstones after removal of the gallbladder, not that there is a residual gallbladder.  

    I did some research and found an article that said you can have subcutaneous abscess formation from spilled gallstones years after Laparoscopic cholecystectomy.  

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