# Component Separation-CPT code and a ICD 10



## CCANTER (May 21, 2016)

I have a procedure where the provider does a component separation with an incisional hernia repair.
I am needing help with the CPT code and a ICD 10 PCS code please
for CPT I have come up with 15734?
ICD 10 PCS   ________

Here is the procedure
Component separation was then performed. This was done by
identifying the rectus muscle in the lateral portion of the hernia, sharply incising medial
to this, separating the anterior from posterior rectus fascia. Using a right angle and
cautery in the superior portion near the umbilicus inferiorly where no posterior rectus was
identified, the peritoneum was separated. This was done sufficiently to create an
adequate retrorectus space and after doing this, the pathology results came back as likely
a serous cystadenoma which is benign. We then decided to proceed with the component
separation and repair of the hernia. After completion of excision of the hernia sac, the
posterior rectus and peritoneum were trimmed and closed in order to medialize the rectus
muscle. This was done using a running 0 Vicryl suture. Several interrupted stitches were
placed more superiorly through. Interrupted 0 Vicryl suture was placed superiorly for the
posterior rectus portion of the incision. At the end of this, an 11 cm long defect was measured with a large retrorectus space adequately developed. 
Hemostasis was assured using cautery. At this point, a Phasix mesh was then trimmed to
size allowing for 6 cm of overlap on either side of the repair. 0 Nurolon suture was used
to secure this in place using several sutures which tacked the posterior rectus laterally,
anterior rectus sheath just lateral to the rectus muscle where no posterior rectus was
available and periosteum of the pubis inferiorly. After adequate placement of the Phasix
mesh, a 10 flat JP was placed within this space and irrigation was re-performed. Anterior
rectus sheath was then closed using running No. 1 PDS suture medializing the rectus
during this procedure towards the midline. The deep subcutaneous tissue had to be
trimmed in order to allow for adequate closure of the skin in this area. This was done
using electrocautery. After this, the deep subcutaneous tissue was closed using 3-0
Vicryl suture followed by superficial closure with 3-0 Vicryl suture and 4-0 Monocryl.


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## CodingKing (May 21, 2016)

I'm thinking 0WQF0ZZ - Repair Abdominal Wall, Open Approach


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## CCANTER (May 23, 2016)

thank you. I was using that ICD 10 PCS code for the repair of the incisional hernia.

Wouldn't I need another ICD 10 PCS code for the component separation?

thanks


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## CodingKing (May 23, 2016)

I wasn't familiar with components separation so I looked it up and it said its a technique to do the abdominal wall repair so I coded to the end result. I found a guide to billing repairs and other than different repair codes there were related to supplementing with tissue substitute.



http://www.davol.com/default/assets/File/HR Reimburse_2016_Pages.pdf


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## avon4117 (May 23, 2016)

CodingKing said:


> I'm thinking 0WQF0ZZ - Repair Abdominal Wall, Open Approach



What kind of code is 0WQF0ZZ? I have never seen it before?


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## mitchellde (May 23, 2016)

That is an ICD-10 PCS code used for inpatient facility coding inpatient only.


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## avon4117 (May 23, 2016)

ok thanks


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## CodingKing (May 23, 2016)

Debra, I know you meant PCS not CM 

Inpatient only procedure coding system. Formerly ICD-9-CM Volume 3. They renamed it and gave its own unique format. Previously it was structured the same way as DX codes but only 2 digits before the decimal. At lease you cant mix them up since the place holder is Z vs X for CM


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## mitchellde (May 23, 2016)

CodingKing said:


> Debra, I know you meant PCS not CM
> 
> Inpatient only procedure coding system. Formerly ICD-9-CM Volume 3. They renamed it and gave its own unique format. Previously it was structured the same way as DX codes but only 2 digits before the decimal. At lease you cant mix them up since the place holder is Z vs X for CM



I did mean PCS !  That is why I should. Not type distracted!  I will edit it so it is correct.  Many apologies guys,


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## CULINTZ (Jul 25, 2018)

Based on the below article, I was considering transfer of (right or left) abdomen muscle, TRAM Flap, Open Approach (OKXK0Z6 or 0KXL0Z6) for the components separation.  If mesh is also used, the PCS code for supplement can be captured as well. Thoughts on this? Thanks.


https://herniacenter.surgery.ucsf.edu/conditions--procedures/components-separation.aspx

Components Separation


Increasing numbers of patients have large or complex abdominal wall defects such as giant abdominal wall hernias or enterocutaneous fistulas where bacterial contamination is present. These may result from from an incisional hernia due to multiple abdominal operations, surgical resection of the abdominal wall or necrotizing abdominal wall infections. Management of complex hernias are more difficult to repair and often have higher rates of recurrence and other complications.

To manage these complex hernias, component separation is one technique that can aid in the repair of these difficult hernias. It is particularly used when there is insufficient muscular wall that can be pulled back together during a conventional hernia repair. *Component separation involves separating and advancing certain layers of the abdominal wall muscle, lengthening them so that the right and left sided muscles can be brought closer to the mid-line for sufficient closure.* This technique restores the structural and functional integrity of the abdominal wall and aesthetic appearance.

A combination of component separation and mesh repair is frequently used to repair giant abdominal wall hernias. Component separation is a complex procedure that is best done in the hands of experienced surgeons, and it is a technique we commonly use.


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## CULINTZ (Jul 26, 2018)

Found the answer in Coding Clinic 4Q 2014. 

Question: A patient was admitted for repair of a recurrent incisional hernia with incarceration and small bowel obstruction. At surgery, after the hernia was excised, the fascia was assessed. On both sides of the abdomen, the external oblique was released from the internal oblique and the posterior rectus sheath was released from the fascia. The fascia was closed and mesh was placed over the anterior rectus sheath. What is the appropriate root operation for the abdomen component release, and is the placement of the mesh included in the component release?
Answer: The abdominal wall is composed of multiple layers (components). In a component separation repair, the layers are separated, so the defect (hernia) can be closed primarily. Since the resulting abdominal wall is now only one layer, it is often reinforced with an additional layer of mesh or other material. If the fascia cannot be closed primarily, then relaxing incisions are made in the abdominal muscle by making additional lateral or posterior incisions to release the muscle. Code the component separation to the root operation “Release.” The appropriate root operation for the placement of the mesh is “Supplement,” since the mesh is being used to reinforce the abdominal wall as well as to prevent recurrence of the hernia. Assign ICD-10-PCS codes as follows:   

0KNK0ZZ  Release of right abdominal muscle,    open approach, for the right     component separation
0KNL0ZZ  Release of left abdominal muscle,    open approach, for the left     component separation
0WUF0JZ  Supplement abdominal wall with    synthetic substitute, open approach    for the placement of the mesh


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