# Foreign body removal (sutures) and fascial defect of upper abdominal wall



## maine4me (Dec 19, 2017)

I could use some help with this operative report.  This was coded as 49560 and 11008 - 51.  I do not see a CCI edit for these codes.  Medicare denied with a CO107 - The related or qualifying claim/service was not identified on this claim.  I am at a loss as to what they are looking for.  Is there a different code that should be used in this case, or is the removal of sutures not separately billable.  I am also not certain about the 49560, should this be billed as 13160.


PROCEDURE AND FINDINGS: The patient was brought to the Operating Room, 
properly identified and placed on the table in supine position. Preop 
diagnosis, procedure and site were confirmed on time out. She had Ancef 
preop. Sequential TEDS were placed. General anesthesia was induced via IV 
and orotracheal tube. The abdomen was first scrubbed with Betadine soap and 
then prepped with Betadine and drapes applied. The wounds were probed and 
the upper sinus tract superiorly and the lower sinus tract slightly inferior 
and medially. The upper one was first opened with an incision going more 
superiorly and carried down sharply. Old granulation tissue was encountered 
which was excised and then a long piece of Tevdek suture was removed. The 
knot was still tied but free, and came out without any problems. The wound 
was then gently probed and it was found that there was a fascial defect at 
the depth of the wound. This defect was then closed with running 0 Prolene 
suture. The wound was thoroughly irrigated. Attention was then turned to the 
inferior wound and incision was made from the sinus tract going more medially, 
and again, the tract was opened and in the depth of the wound another piece 
of Tevdek suture was encountered. This was again removed without having to 
cut it. There was possibly a very tiny fascial defect there as well, and 
this was closed with a figure-of-eight suture of 0 Prolene. Both wounds were 
thoroughly irrigated and no other foreign body was encountered. A culture 
was taken of the upper wound. Both wounds then had a 1/4 inch Penrose 
placed down to the depth of the wound and this was sutured to the corner of 
each incision with 3-0 nylon. Both were injected with 0.25% Marcaine and 
then the skin was approximated with vertical mattress sutures of 3-0 nylon. 
Dressings were applied. Needle, sponge, and instrument count was correct x2 
and blood loss was minimal.


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## cgaston (Dec 20, 2017)

code 11008 can only be billed with 10180, 11004, 11005 or 11006 so that explains the CO107 denial.



I normally code 10121 for the removal of infected sutures, but the fact that this went down to the fascia is throwing me. I can see billing the hernial repair since the fascia was sutured.


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