# Repair after radical soft tissue resect



## cmartin (Jul 19, 2010)

Instructs say simple or intermediate repair included, complex repair or reconstruction to be reported separately.  Did radical resect abdominal wall sarcoma (22905).  Specimen 18.5 x 12.5 x 9.5 cms (actual tumor 13.5 x 9.4 x 5.8). After removing the specimen: "then separated out the peritoneum from what was left of the abdominal wall muscles on the lateral & superior aspect of the defect, & started closing the defect.  We started from the lateral aspect & started approximating the abdominal muscles together. Then as we moved medially we started approximating the abd wall muscles to the periosteum on the ilium bone and we then started #1 PDS from the medial aspect & approx'd the rectus muscle&fascia to the periosteum
and the muscle fascia close to the ilium periosteum.  We then left about a 5x5 cm defect.  We used a Stratus mesh & we laid it on top of the defect & we sutured the mesh w/a #1 Prolene to run and then anchored the mesh to the muscle & fascia underneath it.  We placed it in overlay fashion over the defect. Mesh then anchored to rectus fascia on medial aspect of wound & then to periosteal fascia on posterior & lateral part & then to the abd wall muscles on the superior aspect of the defect.  Then raised more flaps on superior aspect of wound & placed 19 J-P in wound above fascia in subq, then approx'd skin edges w/interrupted 3-0 Vicryl & then stapled the skin.
My Question: would you say this repair/reconstruction is separately codeable, & if so, how would you code it?
Thanks to any & all for your opinions!
Connie M (CPC,CGSC)


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## jackjones62 (Jul 26, 2010)

Hi Connie, although abdominal surgery is not my specialty, I found your question to be a challenge, so here is my response and hopefully it will illicit a response from someone else either agreeing or disagreeing and providing more coding info....

I read the op note, I started with the code you provided, CPT 22905, Radical resection of tumor, soft tissue of abdominal wall; 5cm or greater....My first observation was there were no parenthetical statements directing you to any other coding scenerios; next, it has been my experience when radical resections are done the closure of the wound is inherent to the code, unless there is reconstruction/repair using specific types of flaps; advancing surrounding skin, tissue & muscle into the wound for closure is not separately billable; I read where your surgeon used mesh in the 5x5 cm defect and began to look under abdominal repair and found this statement: "With the exception of the incisional hernia repairs (see 49560-49566) the use of mesh or other prostheses is not separately reported". So with that statement, my response to you is that you cannot code separately for a reconstruction/repair, this is a wound closure; although you may consider addending a modifier 22 to CPT 22905 for increased procedural servics because the closure was complex and took more time.....just a suggestion.

Hope this helps,

Jennifer 
CT ENT


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