# wound washout s/p exp lap



## sundaey

hello everyone,
one of my trauma docs poses the question:

can we bill for an abdominal washout s/p exp lap, and the pt's abdomen is let open?

also, if the pt undergoes multiple washouts (sometimes up to 20) while in the global period, is that billable?

there are no other procedures done, just the washout, and wound vac placement.


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## mbort

yes the washouts can be billed with the appropriate modifier and documentation however many times it takes


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## sundaey

so what code are you looking at?


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## ccaldewey

What codes would be appropriate to use for these washouts?
Thank you


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## CRC CPC

I would be interested to know also.
Thanks


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## Dlee

*Would VAC Washout and changes*

I would be interested in hearing about codes also.  I have used the 97598 codes but the surgeon I work for asked me if we could use the 16000 series codes for treating burns.  He treats non-healing wounds on diabetic patients.  Any advice would be helpful!


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## FTessaBartels

*Burn treatment codes*

Burn treatment codes are strictly for treatment of burns. Can*not* be used for other applications. 

F Tessa Bartels, CPC, CEMC


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## monbel

13160


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## lovetocode

If the abdomen was left open, we wouldn't charge for a closure, would we?  What about 11005?  I would love to hear more thoughts on this.


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## BLOWRIE

we have used 49002 with a 58 modifier.  We have discussed this scenerio at multiple conferences and have not been told this was not acceptable practice.  the vac-pack and all lap pads and packing have to be removed to re-explore and washout the abdomen.  If any of you know of any contraindications for using this method of coding this particular procedure, please advise.  Thanks.


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## FTessaBartels

*10180 vs 97605/06*

The following descriptions are from Encoder Pro

*10180* - This procedure treats an *infected postoperative wound*. A more complex than usual incision and drainage procedure is necessary to remove the fluid and allow the surgical wound to heal. The physician first removes the surgical sutures or staples and/or makes additional incisions into the skin. The wound is drained of infected fluid. Any necrotic tissue is removed from the surgical site and the wound is irrigated. The wound may be sutured closed or packed open with gauze to allow additional drainage. If closed, the surgical site may have suction or latex drains placed into the wound. If packed open, the wound may be sutured again during a later procedure. (emphasis added by FTB)

*11005*- Debridement is carried out for a severe type of tissue infection that causes gangrenous changes, systemic disease, and tissue death. These types of infections are caused by virulent strains of bacteria, such as "flesh-eating" streptococcus, and affect the skin, subcutaneous fat, muscle tissue, and muscle fascia. Surgery is performed immediately upon diagnosis to open and drain the infected area, excise the dead or necrotic tissue. Report 11005 for the abdominal wall, with or without surgical closure of the abdominal fascia.

*49002* - The physician reopens the incision of a recent laparotomy before the incision has fully healed to control bleeding, remove packing, or drain a postoperative infection. 


HOWEVER -- you mention using *wound vac *placement, with these repeat washouts (as many as 20 in post op period).  I'm wondering if what you should be coding is the wound vac only ... *97605-97606. *

F Tessa Bartels, CPC, CEMC


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## LindaEV

I am having the same issue, so I'm gonna bring this one back up...how did you finally decide to code?

Tessa, you gave some descriptions of some "skin" codes. Are these appropriate seeing as how this is really an "internal" thing going on?

From what I understand of wound vacs, these are not usually billed in these situations. In the stated situtation, they are used for more like a drain.

I thought about 49002 as well....but there is no 're-opening' when the wound is left open each time.

This is starting to drive me crazy!

Im thinking of going unlisted, or doing the 49002-52...this would just get cumbersome with so many operations which equals lots of paper claims with attachments if I use those.

Anyone??

Thanks!


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## acbarnes

How about 15852-58? You have to do this under anesthesia and it states for "other than burns." You could argue 49002-58 too if depth of washout is to fascia and again under anesthesia. However, I think in this scenario 15852 may be more accurate. We use 49002 to report re-exploration in recent laparotomies when we are trying to determine the cause of a developing symptom or possible complication. 

Anna Barnes, CPC, CEMC


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