# Exploration/Explantation of FB, abdominal wall



## ksb0211 (Sep 28, 2011)

Hi, all.  I'm hoping for some other thoughts on this one.  I, at first glance, figured this as 11008 but that is an add-on code and the primary codes don't seem to fit so well to me.  So, of course, I'm wondering if there may be another code that more accurately fits and I'm just not seeing it.  Thanks so much for any input.

PREOPERATIVE DIAGNOSIS
Anterior abdominal wall sinus.

POSTOPERATIVE DIAGNOSIS
Anterior abdominal wall sinus.  Rule out fistulization.

PROCEDURE
Exploration of anterior abdominal wall with explantation of retained foreign body.  Application of wound vacuum assisted closure.

DESCRIPTION OF PROCEDURE
The patient was brought to the operating room.  After attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion.  I opened the wound up.  There was a draining sinus laterally; as we dissected this we could see, we thought we found the small bowel.  There was no hole in that bowel but clearly we had fenestrated the abdominal wall.  We went ahead and removed the mesh that had been previously present had been explanted.  All this area was quite adhesed.  We removed multiple pieces of Prolene, some mesh as well, cleaned up the area and found another piece of Prolene laterally.  We then closed over the abdominal wall making sure that we had the small bowel back internally as much as possible, then placed a wound VAC into position after irrigation.  I then secured the wound back to the abdominal wall and placed to suction.  He tolerated the procedure well.
Our concern was that this would eventually result in fistulization.  The patient tolerated the procedure well.


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## ksb0211 (Oct 11, 2011)

Any thoughts?  I haven't been able to get anywhere on this.  LOL  The hospital simply coded it as an ICD-9 (54.0 Incision of Abdominal Wall).  

ANY thoughts would be so greatly appreciated!


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## FTessaBartels (Oct 11, 2011)

*10180*

10180 seems to fit.  

From Encoder Pro
10180  
Incision and drainage, complex, postoperative wound infection  
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. 

Hope that helps.

F Tessa Bartels, CPC, CEMC


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