# Lumbar I&D?



## sxcoder1 (Apr 10, 2017)

Surgeon wants to bill 22015, lumbar incision & drainage, open of deep abscess lumbar. Patient is s/p laminectomy & fusion. Op note states "Inspection of the incision was performed. There was evidence of wound dehiscence with already formation of granulation tissue deep to the skin level. The fascia and the intermediate Scarpa's fascia/fatty layer appears to have healed well. There was evidence of bleeding bed at both sides of the wound. There was no evidence of discharge or purulent fluid. There was no foul odor. Wound measured 7 cm in length 2cm in the maximum width area and 1.75 cm in maximum depth area. At this time the decision was made to proceed with VAC dressing and closure of surgical incision through secondary intention. Closure through primary intention was not felt to be optimal since the wound has likely been dehisced for about 2-3 weeks. Multiple liter irrigation performed of the surgical wound. Silver nitrate VAC dressing was applied. There was good suction without evidence of leak." 

 22015 doesn't seem appropriate to me since he didn't make an incision, and was thinking of 10060 or 10140 or 12020 or 12021 maybe with 97605? I'm stuck. Any input would be appreciated!


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## thomas7331 (Apr 10, 2017)

I would agree that 22015 is not supported if this is all that is documented.  There is no incision or closure documented, so 97605 (or 97607 depending on the type of wound vac) is the only code I see that you could bill.  I'd also note that if this is being done in the global period and not a return to the OR, then this is post-operative care and not billable by the surgeon.


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## Orthocoderpgu (Apr 14, 2017)

I agree with Thomas. It's interesting that the physician specifically states that the deep layers were healing nicely, but then wants to bill for a deep layer procedure and he did not do anything with the deep layers. 22015 is not supported in any way.


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## sxcoder1 (Apr 17, 2017)

Thank you both so much for responding and confirming what I thought!


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