# 13160 vs 49900



## daniel (Mar 5, 2019)

How would this be coded?



CPT 49002

CPT 13160.51



or



CPT 49900





Indications:  Presents with large volume of leakage from incision and wound opening, concern for fascial dehiscence. He was brought urgently to the OR for wound exploration and reopning of ex lap.Pt signed consent, understanding the risks and benefits. 



Diagnosis: Fascial dehiscence





Procedure: 

Wound exploration

Reopening of Ex lap

Complex fascial closure



Findings: Immediately on removing staples it was noted that fascia had completely dehisced, bowel appeared healthy, G tube well secured but tissue as weak throughout. Fascia noted to be weak. 



Detail: The patient was brought to the operating room with informed consent and general anesthesia was induced.  The position was supine.  Sterile preparation and draping of the abdomen was performed.  Preoperative antibiotics were administered.  Time out was performed confirming the patient and procedure. We removed the staples prior to prepping the abdomen and noted complete dehiscence of fascia with exposed bowel. After abdomen had been prepped and draped we removed the prolene fascial sutures and irrigated the abdomen and noted bowel to viable without any injuries.  The previous abdominal closure at outside hospital had torn away from fascia and bowstringed in the midpoint applying pressure to underlying bowel.  This was very carefully inspected and no injury to underlying bowel was identified. The gastrostomy tube was confirmed to still be in good position. It was noted that the patient has significant weakness of fascia and tissue.   Flaps were raised of the skin and sucutaneous tissue to access the fascia because the fascia was too weak to close with a conventional running non-absorbable stitch.  A running 2-0 Vicryl was used to close the peritoneum.  The fascia was then closed with interrupted 0 PDS.  The entire closure was then re-inforced with stratafix suture running imbrication stitch. The skin was loosely closed with staples and packed with tefla in between. Patient tolerated the procedure well without any immediate complications. He was extubated and taken to PACU


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## csperoni (Mar 5, 2019)

*49002*

To me, this is 49002 only.  
Excerpt from https://www.aapc.com/blog/6834-tie-up-the-loose-ends-of-surgical-wound-coding/ 
Closure for a Reopened Wound
Report 13160 also for wound dehiscence closure. If, however, the surgical wound is a laparotomy that has dehisced (split open), you should consider 49900 Suture, secondary, of abdominal wall for evisceration or dehiscence.
Code 13160 includes closing a wound in multiple layers without reopening the wound. Code 49900 includes reopening the entire wound, removing any remaining sutures, and completely resuturing the wound. The latter code also includes replacing any structures that moved through the opening back into the abdominal cavity. If the surgeon completes any additional work within the abdominal cavity, such as exploration, lavage, or repair, consider whether 49002 or another abdominal code is more appropriate.
Codes 12020-12021 are for much simpler wounds that have dehisced and may not be infected. Code 12020 Treatment of superficial wound dehiscence; simple closure only includes single layer closure. If the repair includes layered closure, 12020 is not correct.

With this guidance, I would code 49002 only.  The closure would be included in the laparotomy.


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