# Bowel resection x 2 with delayed anastomoses



## andreagail (Sep 17, 2012)

I need some help with this, pt had several areas of ischemic intestine, some of which were removed. In an effort to save as much small bowel as possible, wound vac was applied (description to follow), patient was left in ICU to resuscitate small bowel and the anastamoses were performed 2 days later. My question is how to code for these procedures. 44120 and 44121 are the obvious codes but should I use modifier 52 or 53 for the initial surgery and bill the wound vac as well on this first date of service and then bill the codes again as a staged procedure on the date of service when the anastomoses were actually performed? Here is the description of the wound vac:
"Large amounts of warm saline irrigation were used to wash out the abdomen. A Bogota bag was then placed over the small intestine and an x-ray detectable lap was placed inside the abdomen inside the Bogota bag. Two Blake drains wre palced over this lap and 1 more additional lap was placed over along wwith a loban to create an occlusive abdominal cavity packing that will function as a wound VAC." The patient was returned to the ICU at this point, 2 days later, a further assessment was made regarding the viability of the intestine in question (it was viable and therefore could be saved) and the anastomoses were performed. Any input/suggestions/help with this would be most appreciated!


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