I have a physician who did a laparotomy w/repair of a ruptured aortic aneurysm (35092). A couple of days later, he reopened the incision (49002) and placed a Wittmann patch and a wound vac (97605). On 4 separate occasions after that, he opened the patch, inspected the abdominal cavity, performed lavage, closed the patch and reapplied the wound vac (97605). Can we bill for a reopening of a recent laparotomy each time he opens the patch and lavages? If so, would the correct coding be 49002-58-52? At the fifth and last session, he removed the patch, closed the fascial layer, left the subq layer open and reapplied the wound vac (97605) Could you please suggest how to code for this?
Hi, It's hard to tell without the actual op notes. However, if they are actually going into the abdominal cavity for lavage that is more than just changing a VAC dressing.
We would code 49002 (M58, M52). We use M58 to indicate that it is a staged procedure, and M52 to show reduced service (since they do not have to re-OPEN the abdomen in these cases). We never code the VAC dressing when there is a definitive surgical procedure; just as you would not code the suturing of a surgical wound. It is the method of closure (albeit temporary). If they change the dressing, maybe taking a quick look at status of wound healing, then we code 97605 (Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters).
Fas-cial closure immediately after definitive repair of injuries was defined as “early fascial closure. ” Continuation of the open abdomen beyond the definitive repair of injuries with subsequent fascial closure was defined as “delayed fascial closure.” Since April 2004, the Wittmann Patch was uniformly employed in open abdo-men management. The Wittmann patch can be used to perform a temporary abdominal closure (TAC) or open abdomen (OA) as part of damage control surgical interventions in trauma, peritonitis or pancreatitis and generally in all those conditions at risk of intra-abdominal pressure (IAP) increase.
Please check your documentation once before coding. Also, please refer to the following link for further clarification.
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