# Loss of Domain



## AlaskanCoder (Dec 28, 2015)

In ICD-9-CM Vol 1, when the surgeon documented loss of domain in an abdominal surgical wound, we were advised to use ICD-9-CM code 879.3 for Open wound of abd wall, anterior, complicated. See "Expose the Layers of Abdominal Wall Reconstruction"   In Coding Edge  June 25, 2010  By John F. Bishop, PA-C, CPC, CGSC, CPRC
However, in ICD-10-CM, rather than complicated open wounds, we now specify if it was by laceration, puncture or bite and if there was penetration into the peritoneal cavity and with or without a foreign body.  I don't feel that any of these descriptions fit for loss of domain in an open abdominal surgical wound.  
The patient had a ruptured AAA with a massive retroperitoneal hematoma which resulted in abdominal compartment syndrome.  The surgeon left the abdomen open and placed an Ab-Thera wound VAC.  My surgeon was called in to manage the open abdomen.  When he brought the patient to the OR and removed the wound vac, the patient was "found to have complete and total loss of domain with a massive retroperitoneal hematoma resulting in evisceration of this entire intraperitoneal hollow viscera."
I am seeking advise on how to code the loss of domain and evisceration. 

Thank you in advance. 
Karen


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