# Delayed Prior Closure of Abdominal Wound



## FLSJarrel (Jun 2, 2011)

Would the diagnosis of Open Abdominal Wound 879.3 support the delayed prior closure of abdominal wound using CPT 13160.  Below is the op report.

POSTOPERATIVE DIAGNOSIS:	OPEN ABDOMINAL WOUND

OPERATION: DELAYED PRIOR CLOSURE OF ABDOMINAL WOUND

INDICATION: The patient had presented to the hospital with small bowel obstruction 2 weeks ago.  She had small bowel obstruction due to an incarcerated right sided abdominal wall hernia. She was taken to the operating room and lysis of adhesions was done and mesh placement was performed. She did have an abscess develop with infection of the mesh and small bowel perforation.  She had a section of the bowel removed with abdominal wash out and the Vicryl mesh was used to close the fascia.  The subcutaneous tissue was irrigated and a wound vac was placed.  The wound has been monitored very closely and subcutaneous tissue appears clean.  I decided to bring her back to the operating room for delayed primary closure.  

FINDINGS:	The subcutaneous tissue looked healthy and no drainage was identified.  The mesh appeared intact.  

TECHNIQUE: The patient was wheeled into the operating room, identified and laid in the supine position. She was given intravenous sedation.  The abdomen was prepped and draped in standard sterile fashion.  Preoperative antibiotics were not given as this was a delayed primary closure.  The wound vac had been disconnected and the sponges removed.  I irrigated the wound with about 500 c.c. of normal saline.  Good granulation tissue was identified.  I made a stab incision in the right lower quadrant and tunneled a JP drain from there into the wound.  The drain was secured in place with 2-0 nylon stitch. I then freshened the skin edges and closed them with deep vertical mattress sutures.  The skin edges were approximated with staples.  Wounds were clean and dressings applied. The patient tolerated the procedure well. 

I am just starting to code for surgery, so any help would be appreciated.


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## Treetoad (Jun 2, 2011)

I'd look at 13160.


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## FTessaBartels (Jun 8, 2011)

*V58.41*

I'd use V58.41 as my diagnosis for a delayed primary closure.

F Tessa Bartels, CPC, CEMC


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