# HELP!! - Excision Chronic Sinus Tract



## mgord

op note reads:
Excision chronic sinus tract at the umbilicus
Excision of umbilicus
Intermediate Wound Closure

Umbilical area prepped and draped. Elliptical incision was made transversely around the umblicus to include the previous scar on the sinus tracts. Dissection carried down around the sinus tracts down to the fascia. We did enter the sinus tract at one point and cultures were obtained. These tracts clearly dissected all of the way down to the fascial layer as the Ethibonds were clearly visible at the base of the tracts. We excised a portion of the fascia to include the sinus tracts as well as all of the previously placed sutures. This was carried back to healthy viable tissue. that was removed and sent for pathological evaluation. Wound copiously irrigated and hemostasis assured. After the excision, it did appear that this included at least a partial thickness of the fascia if not the full thickness, therefore fascia was closed transversely with multiple figure of eight 0-Vicryl sutures. Wound then closed in two layers with interrupted 3-0 Vicryl and interrupted 4-0 Monocryl. 

This surgeon seems to do alot of these sinus tract excisions and I always have such a hard time figuring these out. Does anyone have any suggestions on the CPT I should look to for this procedure? Any suggestions would be so greatly appreciated 

Thanks!!
MB


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## mjewett

My surgeon does these all the time too. We bill codes 13160, and 15002.  Talk to your surgeon and see what they think.

Melissa-CPC


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## mgord

I thought that 15002 could only be used when the wound requires a skin graft of some type.
I was thinking either the 13160 or using 10121 with 12032. I know that the facility billed 11005 but I dont think that is correct.


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## Norma Cravey-Fabian

I had one of these myself. After I discussed it with another coder in the office  we agreed upon 13160.

Norma, CPC


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## mjewett

I learned last year at a coding conference that if the sinus tract is along a previous incision it may be appropriate to code 15002. The description of the code reads surgical preparation *or* creation of of recipient site by *excision* of open wounds , burn eschar, *or scar...

The post op fistula is a scar that is not healing or reopened, when they excise the scar, and perform a secondary closure I use codes 13160 and  15002.*


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## hmanning

*Excision of draining sinus*

How about just the excision of a sinus tract status post inguinal hernia repair. The VAC was placed after the tract was excised and wound area debrided so there was no closure. At odds......anyone have ideas?


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