# Staged partial abdominal wound closures



## cindyseyer (Feb 4, 2008)

I would like your input on how to code this procedure:
Our patient has had a previous abdominal surgery with Permacol mesh placed.  Due to small bowel distention and edema, the abdominal wound would not close.  A few days after the initial surgery, he underwent a staged partial abdominal closure described as:
   The Permacol mesh was incised in the midline nearly its entire length.  The ProTak stapler was used to reinforce the fascial attachments circumferentially.  The Permacol was then reapproximated with running #2 nylon overlapping approximately 1 cm on both sides.  A wound VAC was placed.
   Four days later, this procedure was repeated for tightening of the closure:  The suture in the middle of the Permacol mesh was removed and the small bowel gently dissected free from the deep side of the Permacol with blunt dissection.  Approx. 1 cm was trimmed from the Permacol and the remaining mesh was reapproximated with running Prolene suture.  A new wound VAC dressing was placed.

Suggestions?  I am thinking of CPT 13160-58, but am not sure if this addresses a staged procedure or simply the final wound closure...


----------

