A 61-year-old male patient with history of recurrent perirectal abscesses and fistulas, status post multiple incisions, drainages, and debridements, underwent surgical treatment of a complex recurrent fistula in ano with placement of a holding seton. During surgery, a probe was placed in the external opening where the fistula was deep into the perineal subcutaneous tissue and fascia (ischiorectal space). Electrocautery was used to open the tract in the direction of the rectum. The probe was passed around the sphincter, and a vessel loop was placed around the remaining tract and sphincter muscle, and tied to itself as a holding seton. The tract consisting of perineal subcutaneous tissue and fascia was excised and curetted. What is/are the appropriate root operation(s) for the fistulectomy with holding seton?
The fistula begins two inches from the anal verge and extends into the ischiorectal space, in the deep fascia of the perineum. The tissue is excised from the fascia, not the gastrointestinal (GI) tract itself. The definitive procedure is cutting out the upper part of the fistula tract in the fascia. The stitch seton uses suture material to promote healing (a common function of sutures). This technique is different than reapproximating the edges of a wound but it is secondary to the fistulectomy. In this procedure the seton is placed to keep the rest of the fistula draining to promote healing. Assign the following ICD-10-PCS code for the fistulectomy with holding seton:
0JBB0ZZ Excision of perineum subcutaneous tissue and fascia, open approach