# Chronic Granulation Tract excision



## ASC CODER (Dec 17, 2010)

The left upper abdomen was prepped and draped in a sterile fashion and an elliptical incision was used to excise the old scar from a previous jejunostomy tube site in the left upper quadrant. This incision was carried into subcutaneous tissue and a palpable, tubular indurated structure was identified and followed carefully into the deeper aspects of the wound. At the level of the external muscular fascia, the tract became slightly wider, and seems to communicate with the peritoneum. Carefully, the layers were dissected and divided and the tract was excised. At the base of this tract was a large permanent suture obviously leftover from her previous surgery many years ago. There is no involvement of bowel wall or identifiable abscess at the depth of this dissection. The tract was removed from the field, and the defect was closed with 3-0 Vicryl in the peritoneal layer, interrupted 0 Nurolon in the muscle fascia, and fine absorbable suture in the subcutaneous tissue and skin


Incisional hernia??49560?


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## Lesainc (Dec 17, 2010)

What about 11005?  ?11008


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## ASC CODER (Dec 17, 2010)

Well looking at the procedure desk reference those codes have to do with an active infection like necrotizing skin disease etc. what do you think about 22900?


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## surgonc87 (Dec 20, 2010)

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


The physician secondarily repairs a surgical skin closure after an infectious breakdown of the healing skin. After resolution of the infection, the wound is now ready for closure. The physician uses a scalpel to excise granulation and scar tissue. Skin margins are trimmed to bleeding edges. The wound is sutured in several layers 

MS


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## acbarnes (Dec 21, 2010)

See note under code 49900 (Abdominal wall secondary suture), use 11042 or 11043
for debridement of abdmominal wall. I would use 11043 since he goes to the muscle to excise the tract. 

Anna Barnes, CPC, CEMC, CGSCS


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