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Closure codes

Please help with the following: Do you code for the complex closure of the lower lid if a flap closure is performed as well?

PREOPERATIVE DIAGNOSES: Open wound of right lower lid, status
post Mohs excision, right lateral canthal laxity, defect of
right cheek, right forearm mass, right wrist mass.
POSTOPERATIVE DIAGNOSES: Open wound of right lower lid, status
post Mohs excision, right lateral canthal laxity, defect of
right cheek, right forearm mass, right wrist mass.
PROCEDURES PERFORMED:
1. Flap closure of right lower eyelid and cheek.
2. Right lateral canthoplasty.
3. Right orbicularis oculi muscle flap.
4. Complex closure of right lower lid, 1.5 cm.
5. Recreation of right lateral lid canthus with adjacent
tissue transfer of 1.5 cm2.
6. Excision of right forearm mass, 1.2 cm superficial.
7. Flap closure of right forearm.
8. Excision of right wrist mass, 1 cm deep.
9. Intermediate closure of right wrist.
10. Right supratrochlear, right supraorbital and right

Medical Billing and Coding Forum

Laparoscopic Closure of Peritoneum Post Hernia Surgery

Please help resolve a dispute. One coder believe that this should be billed 44620 another 49329. Any input would be appreciated.

OPERATION PERFORMED:

1. Diagnostic laparoscopy.
2. Reduction of internal hernia.
3. Closure of peritoneum.

PREOPERATIVE DIAGNOSIS: Small bowel obstruction.
POSTOPERATIVE DIAGNOSIS: Small bowel obstruction.

DESCRIPTION OF PROCEDURE: We used the same infraumbilical 5 mm incision and
reopened the incision. Due to his recent surgery, we used the same opening to
enter a 5 mm port with a blunt tip. Once the port was entered, insufflation was
obtained. Two additional ports were placed initially 5 mm on the left and right
side of the umbilical port. On initial evaluation, the patient had a loop of
small bowel going into the peritoneum, which appeared to be herniated through
the peritoneal defect, even though it appeared that the peritoneum had split
open. Using 2 blunt graspers, we were able to reduce the small bowel out of
this defect and evaluate the small bowel which appeared viable and pink. The
small defect which measured roughly 1 cm was closed with intracorporeal suture
using 3-0 Vicryl suture, using a figure-of-eight suture. In order to do that,
we did have to insert a 12 mm port on the left side. Next, we evaluated for any
other defect and we did not find any other issues, so at this time desufflation
was achieved and the fascia of the 12 mm was closed with interrupted
figure-of-eight Vicryl suture. The skin of all the incision was closed with 4-0
suture. Local was injected. Sterile dressings and Dermabond were placed over
the skin incisions. All sponge, needle and instrument counts were correct at
the end of the procedure.

Medical Billing and Coding Forum

Debridement and Secondary complex closure of wound dehiscence of bilateral breasts

Assistance needed in coding this case for our ASC.

The physician wants to code as 11010 X 2 & 13160 X 2; however, those codes bundle leaving us with just 13160 as the procedure was performed in the same anatomical site.

My question is, would it be appropriate to code 13160 and 19340 LT for the extra work that went into the left side with the implant being removed, cleaned and replaced?

Pre/Post Op Dx: Bilateral incisional dehiscence of breast reconstruction, status post bilateral mastectomy and immediate reconstruction.

Procedures Performed:
1. Debridement of bilateral breast
2. Secondary complex closure of wound dehiscence of bilateral breast

Indications and Findings:
Patient approximately one month status post bilateral mastectomy and immediate reconstruction using AlloDerm and a permanent implant. Today in followup, she was noted to have dehiscence of her incisions bilaterally. On the right, she remained with viable muscle at the base of her dehiscence; however, on the left, there was exposure of her underlying AlloDerm, and is now returned to the operating room for a secondary closure and attempted salvage.

On the right, the patient was noted to have incisional dehiscence; however, the pectoralis muscle remained viable at the base of the wound. There was no evidence of purulence. On the left, there was exposure of the underlying AlloDerm covering the implant. However, again, there was no evidence of purulence or significant infection. On the left, the wound was initially profusely irrigated with a Pulsavac irrigation system. The implant was then removed, and the entire wound again thoroughly irrigated, and the implant was soaked in Betadine for approximately 25 minutes. The implant was replaced and the wound secondarily approximated as described below.

Description: After anesthesia, the left breast wound was then cultured following which the anterior chest wall was prepped and draped in the usual sterile fashion. Nonviable tissue along the margins of both incisions were sharply debrided. Both wounds were then irrigated with the Pulsavac irrigation system using a betadine saline solution. On the right, the patient was noted to have viable pectoralis muscle at the base of the area of dehiscence; however, on the left, there was exposure of the acellular dermal matrix. The matrix was transected at the area of dehiscence and the implant removed. Again, there was noted to be no evidence of any purulence whatsoever within the pocket. The implant was completely submerged in a betadine solution following which the pocket on the left was again irrigated with a Pulsavac irrigation system. The entire operative field was then broken down and reprepped and draped in the usual sterile fashion. The pocket on the left was then again irrigated with 3 liters of a betadine/saline solution following which the implant was replaced within the pocket. The dehiscence was then approximated using interrupted sutures of 3-0 Vicryl to approximate the acellular dermal matrix in deep subcutaneous tissues. The wound was again irrigated with the Pulsavac irrigation system and the skin approximated using interrupted horizontal mattress sutures of 3-0 Prolene. On the right, the wound was reapproximated using interrupted horizontal mattress sutures of 2-0 Prolene. A sterile dressing consisting of xeroform gauze and Tegaderm was applied following which the patient was taken to the step-down unit in stable condition. All counts were correct. There were no complications.:confused::confused:

Medical Billing and Coding Forum