# Closure of fasciotomy incisions - Can anyone tell me



## GIBBERS

Can anyone tell me if we are allowed to code for the closure of the 'decompression fasciotomy' incisions? (cpt 27600-27602)

if so, do i use the cpt codes under the 'repair (closure)' codes (12000-13000 series) 

if it is bundled with the primary surgery, where can i find this information to show our surgeon?

Thanks so much for your help!


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## Lujanwj

You can not bill for the closure as it is inherent to the procedure.  See NCCI Policy Manual Chapter 1  Section B. Coding Based on Standards of Medical/Surgical Practice.  

https://www.cms.gov/NationalCorrectCodInitEd/Downloads/NCCI_Policy_Manual.zip

Good Luck!


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## colorectal surgeon

Well, I'll just argue as the devil's advocate.  

1) I would expect that most patients require a return to the operating room for closure of fasciotomy incisions.

2) The purpose of of fasciotomy is to decompress and therefore the closure is never done at the same setting as the fasciotomy.

Maybe I'm off base here.  But you might also post in the ortho section and see what people say.


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## FTessaBartels

*Cpt 13160*

Per Encoder Pro description of fasciotomy the wounds are left open and delayed closure is separately reported.

I would use CPT 13160 for the closure (don't forget your 58 modifier)

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## jmcpolin

13160 states post infectious breakdown, would you still use that?


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## Lujanwj

@Devils Advocate ;o) Didn't find anything in NCCI Chpt 4 regarding this; however, I was able to dig up an old Complete Global Service Data book from the A.A.Orthopedic Surgeons (not the AMA but holds some weight).  They state that Simple and Intermediate repair is included in the codes 27600-27602  but Complex closures are separately billable on the same date of service.  Obviously, these rules don't apply to a different date of service; in which case, you would code the appropriate repair (doesn't have to be complex) the DR does with the use of modifier -58 (assuming patient is still in Global).


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## FTessaBartels

*Cpt 13160*



jmcpolin said:


> 13160 states post infectious breakdown, would you still use that?



13160  
Secondary closure of surgical wound *or *dehiscence, extensive or complicated  

The word "or" means you do NOT have to have both conditions. So secondary closure of a surgical wound is appropriate use of this code.

Hope that helps.

F Tessa Bartels, CPC, CEMC


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## Lujanwj

13160 
Secondary closure of surgical wound or dehiscence, extensive or complicated 

I'd consider using the standard repair codes (13100's only - day of procedure, 12001-13102-58 globally). If the wound has never been closed it can not be a secondary closure by definition.


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## jmcpolin

I was reading the lay description


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## brittany1356

Here is the full description of 13160:

Secondary closure of an extensive or complicated surgical wound or wound dehiscence is performed. This procedure covers two scenarios, *one in which the surgical wound is not closed at the time of the original surgical procedure *and another in which a surgically closed wound opens along the previous suture line. _Secondary surgical wound closure is performed on a date subsequent to the original surgical procedure during a separate surgical session or encounter._ The edges of the open surgical wound are trimmed. The deepest layers may be closed with absorbable sutures and the knot buried followed by closure of superficial layers with non-absorbable sutures. If retention sutures are used to hold the edges of the wound together without tension, they are placed through the entire thickness of the wound, a short length of plastic or rubber tubing is threaded over each suture and each suture is then tied. Stents may also be used to hold tissue in place or maintain the opening of an orifice. Care is taken to carefully align wound edges to prevent scar depression. Secondary closure of a wound dehiscence is performed on a wound that has opened at the site of the earlier repair. The extent of the wound dehiscence is evaluated. The wound is irrigated with sterile saline or an antibiotic solution. The previously placed sutures are removed and the edges of the wound are trimmed. Any necrotic tissue is debrided. The wound is then repaired as described above.


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