# Component separation technique



## bpiggott (Oct 12, 2009)

Could someone help code the following case:


 Postop Dx: Loss of abdominal domain 

Name of Operation: Component separation technique w/myofascial advancement flap for delayed primary closure of abdominal wound & restoration of abdominal wall anatomy. 

  Description of Operation: 

The vacuum assisted closure device was removed. His abdomen was 
inspected, there was no evidence of fistula mesh. The skin edges 
demonstrated good viability with excellent granulation tissue in the 
wound. Its overall appearance was clean. It was irrigated with 5 
liters of normal saline. The stomas were pink & functional. I then 
made the decision to attempt a closure of his abdomen. I did perform a 
further component separation technique with further elevation of his 
rectus muscle & anterior fascia off of the posterior fascia. This was 
carried out laterally approximately 2 to 3 cm beyond the lateral borders 
of the rectus muscle, aside from adjacent to his ileostomy & mucous 
fistula. This was done on both sides of his abdominal wall. I then 
continued further advancement of the skin flaps involving just above the 
anterior fascia. Again, this was carried out approximately 3 to 4 cm 
beyond the lateral borders of his rectus muscle on both sides of his 
abdominal wall. I then created four relaxing incisions of the anterior 
fascia. This was approximately 3 to 4 cm beyond the lateral border of 
the rectus muscle both above & below the stoma sites. This incision was 
made through the returns today for & down through to the muscle. This 
allowed for further advancement of the rectus flaps to be mobilized 
medially for closure. There was an are of exposed bowel with no 
evidence of fistula formation that was imbricated with the biologic mesh 
to allow closure of this. CloSeal was used to cover this to help 
prevent fistula formation in this region. I then placed four 19-French 
Blade drains that lay on both left & right below the posterior fascia & 
below the rectus muscle. These were exteriorized at the inferior 
quadrants of his abdomen & secured to the abdominal wall with the use of 
2-0 nylon. I then placed 2 additional 19-French Blake drains that were 
exteriorized at the superior quadrants of his abdomen. These lay in the 
skin flaps above the rectus muscle & again were secured to the abdominal 
wall with the use of 2-0 nylon. 

I then began a single-layer closure of his abdomen reapproximating the 
fascia just medial from the rectus muscle emcompassing both the anterior 
& posterior portions. This was done from the superior canthus to the 
midline & from the inferior canthus to the midline with the use of #1 
looped PDS with every third throw in a locking fashion. I was able to 
reapproximate this under no tension. I then irrigated the subcutaneous 
tissue, reapproximated the skin flaps that were created with the use of 
3-0 Vicryl in a simple inverted interrupted fashion & skin clips. I 
then placed a bolster incision back directly over the incision line in 
the usual standard fashion, which was hooked to 150 mmHg of pressure 
continuous suction with high intensity. A drape was placed over the 
incision line that was fenestrated right down the middle directly over 
the skin clips & this acted as a bolster incisional VAC, which was 
secure & functional. Appliances were then reapproximated to his 
ileostomy & mucus fistula. The general endotracheal anesthetic was 
reversed, he was transferred off the operative table & to the 
postanesthetic care unit in stable & satisfactory manner.


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## acbarnes (Oct 12, 2009)

CPT 15734 for abdominal componet seperation, use 15734-RT and 15734-LT to indicate both sides were done. I believe you can bill it 15734-50 too, but we bill as a RT and LT. The carriers seem to like it this way. Mesh is included and not billed seperate. 

Anna Barnes, CPC, CGSCS


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## bpiggott (Oct 13, 2009)

Thanks so much for your help.

Beth Piggott, CPC


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## philwjp (Mar 31, 2017)

15734 cannot be billed with 50, RT, LT as it is not assigned laterality.  You can use 59 or the X_ codes with it.  My surgeon insists there is a separate code for component separate besides the 15734.  Does anyone know of a separate code?  Thanks.


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