# delayed primary closure



## pituffs (Jul 7, 2009)

the pt underwent a hartmann's procedure and his wound was treated open with a wound vac he is not ready for delayed primary closure. the dr. has a procedure note of 

with the patient supine, the wound vac is removed. the wound is painted with benzoin and reapproximated with half-inch steri-strips. 

can i code this? or it woudl it be inclusive the sx the dr. states code 12020


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## ARCPC9491 (Jul 7, 2009)

The wound vac would be bundled into the procedure and not seperately codeable.


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## pituffs (Jul 7, 2009)

right but the actual delayed closure could be billed 12020?


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## ARCPC9491 (Jul 7, 2009)

Actually, I would use 13160 for the delayed closure.


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## RebeccaWoodward* (Jul 7, 2009)

Hmmm...I'm inclined to say no.  Adhesive strip closure, *alone*,  is not reported with the repair codes.


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## RebeccaWoodward* (Jul 7, 2009)

But doesn't 13160 require layer suturing?  Unless I'm missing it, I only see steri strips


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## ARCPC9491 (Jul 7, 2009)

I'm assuming this was done laparoscopically?  it's hard to tell exactly from the brief note. In that case, like Rebecca said, steri strips aren't going to justify the use of any delayed closure.

If open, that's a major surgery, use 13160


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## pituffs (Jul 7, 2009)

that's all the dr. states is his procedure note. i don't think we can bill for that i would think is part of the sx, the delayed closure.


PROCEDURE 
With the patient supine, the wound VAC is removed. The wound is painted with benzoin and reapproximated with half-inch Steri-Srips. The patient tolerated the procedure well.


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## dmgomez (Jul 10, 2009)

If  he just put the steri strips that becomes a part of the global surgery package. looking at the the decription of the code 12020 states that it is "sutured in a single layer" so that would not be correct. There is a code 12021 if he left it open and packed it.

as for the 2nd closure it depends if it is simple then I would use the 12020 but if it is extensive or complicated I would use the 13160.


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