# need assistance coding



## jalbright0516 (Jul 8, 2009)

I have an op report that is for an abdominal washout with skin closure -- please see attached note.

I am struggling with the code to use because the 3m coding software is leading me to an unlisted procedure

I feel that the code is either 49000 or 49900 or even the code of 20102(but for this there was not a foreign body in the patient)

Any assistance would be appreciated.    
______________________________________________________________
PREOPERATIVE DIAGNOSIS:  Status post colostomy reversal.  Status post
bowel resection.

POSTOPERATIVE DIAGNOSIS:  Status post colostomy reversal.  Status post
bowel resection.

PROCEDURE:  Abdominal washout with skin closure.



BRIEF HISTORY:  Ms. Graham is a 61 year old African-American female
who has recently been taken to the operating room for a perforation of
her small bowel.  She had a small bowel resection and fascia closure
of her abdominal skin was open.  She is being taken to the operating
room for washout of her skin.

DESCRIPTION OF PROCEDURE:  The patient was taken back to the operating
theater and placed on the operative table in the supine position.
Upon proper identification at the time of the procedure, the patient
was sedated, prepped and draped in a sterile fashion.  We then
irrigated one liter of normal saline of the subcutaneous tissue.  We
then reapproximated the skin with the staple.  In the inferior portion
of the incision, I did reapproximate the subcutaneous tissue with
interrupted 2-0 Vicryl suture.  We then reapproximated the skin with
skin gun.  All counts were correct.  The patient was transferred to
PACU in stable condition.


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## fredabrinson (Jul 10, 2009)

*Probably need to discuss with the physician*

Hello Jalbright0516,

This procedure notes seems to be confusing, as the diagnosis doesn't seem to match the procedure name, and the procedure name doesn't seem to match the procedure description!

It reads like a wound dehiscence but I would not code it as such without the physician agreeing to this and providing an addedum to the existing report.

I do not agree with the codes of 49000 nor 20102 as the report does not support either code.

Good luck!


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## Erica1217 (Jul 10, 2009)

Looks like a 12020 to me.  


 Erica


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## LTibbetts (Jul 13, 2009)

I agree with Erika on the 12020. I have the 3M software as well and it does sometimes lead you to the wrong codes. I usually trust it with my Dx codes (because I know a lot of them by heart), but I ALWAYS double check my CPT book for my procedure codes. Actually, I usually start with the book and then go into 3M. It may sound old school but it has always worked for me.


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## mitchellde (Jul 13, 2009)

Try using keywords of seconday wound closure or postoperative wound closure.  This should take you to the 12020 code in 3M.  This looks like a planned postoperative wound closure but that wouls still be the correct code, your ICD-9 will be the dx for delayed closure.  This is common following a bowel perforation due to the possiblity of infection.


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