# Abdominal washout & wound VAC removal w/fascial closure



## bill2doc

Help with CPT code please  Thank you in advance 

The patient is a 30-year-old male who presented on March 4th with acute pancreatitis.  He has had a complicated hospital course and required debridement of his necrotic pancreas.  

DESCRIPTION OF PROCEDURE:  The patient was brought to the Operating Room and placed in supine position.  The wound VAC was removed.  The patient was noted to have 2 Abramson drains, one on either side, with the drain on the left lying in the distal pancreatic bed and the drain on the right close to the pancreatic head and duodenum.  The abdomen was irrigated through the drains which were removed and then replaced.  Of note, there was minimal frankly necrotic debris that returned through there.  There was some bilious fluid noted on the right side.  This was irrigated and removed.  No acute leak was noted and no visible perforation was identified.  Attention was then turned towards the abdominal contents, where the bowel grossly appeared to be inflamed and coated with fibrinous material.  It was a large mass and evaluation of the bowel did not appear to be in favorable condition for placing a jejunostomy tube without significant amount of adhesion lysis and a potential enterotomies.  Given this patient's potential for an enterocutaneous fistula already, the decision was made to avoid placing a jejunostomy after this evaluation.  The abdomen was again copiously irrigated with sterile normal saline.  At this point, the fascia was examined and was noted to be intact and appeared to be able to be appropriately reapproximated.  Interrupted 0 Ethibond was used to reapproximate the Chevron incision at the apex and continueous 0 PDS were used to close the fascia.  The subcutaneous tissue was left open and the wound VAC was again replaced overlying the fascial closure.  The replaced Abramson drains were sutured in place using nylon sutures and then placed to suction.


----------



## syllingk

I am thinking 49084 and 97605


----------



## Mcbrown30034

*Re Abd wash and wound VAc change*

There is no code such as 49084,The most likely one would be 49080 and 97605
for status post anastomotic leak with open abdomen


----------



## Kisha

*McBrown incorrect*

There is no code such as 49084,The most likely one would be 49080 and 97605
for status post anastomotic leak with open abdomen 

CPT 49080 is no longer in use. the previous coder was correct to use 49082-49084.


----------



## gared111

49084 is in both my 2012 & 2013 CPT book. The code was new for 2012 and has not been deleted from what I can tell.


----------



## qcs555@wildblue.net

49084 is a code in my 2015 cpt book.  Peritoneal lavage, including imaging guidance, when performed.


----------

