# Is this closure billable?



## coder25 (Sep 30, 2009)

Hello,

My DR performed an umbilical hernia repair which was incarcerated.  He wants to bill out a first-degree closure which involved Ethibond pop-off sutures tranversely, two figure of eight sutures transversely and the umbilical stalk base was pexied to the fascial closure using 3-0 Vicryl.  The deep subcu tissues were reapproximated to prevent seroma formation using 3-0 Vicryl in an interuppted fashion.  

Can this be billed out or all major surgeries repair included? If it can, which repair code would this fall under?

Thanks fo the help!


----------



## FTessaBartels (Sep 30, 2009)

*Closure included in surgery procedures*

With the EXCEPTION of lesion excisions (integumentary section ONLY) that require more than a simple closure, all surgical procedures INCLUDE the closure of the wound.  *Not separately billable.* 

F Tessa Bartels, CPC, CEMC


----------



## coder25 (Sep 30, 2009)

Thanks Tessa!

That's what I thought, but I wanted to be sure.


----------



## LaSeille (Oct 9, 2009)

FTessaBartels said:


> With the EXCEPTION of lesion excisions (integumentary section ONLY) that require more than a simple closure, all surgical procedures INCLUDE the closure of the wound.  *Not separately billable.*
> 
> F Tessa Bartels, CPC, CEMC



This is exactly what I have been explaining the surgeon I work for, but I cannot find it in writing.  Can you tell me where I can find this in writing so that I can present it to him?    Thanks!


----------



## caroline75771 (Sep 24, 2010)

Tessa,
An excision of breast lesion identified by preoperative placement of radiological marker; single lesion was performed.  Would this code (19125) also include wound closure of tissue defect or can it be coded separately and do we have the appropriate documentation to code wound closure size?

 See below:
The left breast was prepped and draped in the usual sterile fashion after the wire was trimmed to about 5 centimeters from the skin. outflow. Please note that Venodynes were placed and started before the sedation was begun. The wire exited the skin very laterally. Almost at the anterior axillary line medial to that at approximately the 2:00 axis and 6 is a large hypertrophic scar from the stereotactic biopsy about 5 mm big. 

The incision was made in an elliptical fashion in the circumareolar direction to include this scar in a 4 cm incision. The ellipse of skin with the scar included was sent separately to pathology. Sharp rakes were used to lift the skin and the dissection was carried in the subcutaneous tissue laterally to where the wire entered the skin. The wire was then drawn into the surgical cavity and followed down to where a thick chunk of tissue which was hard and nodular was encountered. This is where the thick portion of the wire passes through and so this entire area was removed. It measures about 4 cm by 2 x 2 centimeter. This was marked with a short stitch superior and a long stitch lateral. The lateral stitch is at the lateral extent of the lesion where the needle exits the skin. This was sent to pathology. 

Because of long distance it took to tunnel from the lateral portion of the breast to this lesion, which was in essence in the midportion of the breast, there was a large tissue defect measuring about 10 cm by 5 x 3. It is raised in a medial to lateral fashion, and so while the tissue defect is there, it closes down easily so I used interrupted Vicryl sutures to reapproximate the deep tissues so that there would be no deformity and once this long tunnel was closed, the skin was closed in multiple layers. 

Once the incision was completely closed, the skin was covered with Steri-Strips, 2 x 2's and Tegaderm. 

The patient tolerated the procedure with no complications and was taken in stable condition to the recovery room.
Thank you!


----------



## caroline75771 (Sep 24, 2010)

Does anynone have any thoughts??


----------



## Grintwig (Sep 24, 2010)

In my opinion the closure is included in the procedure Caroline. 
I believe the only codes that you can code a more intensive closure on are the lesion removal integumentary (*skin*)codes *excluding* the breast codes. If I remember correctly the closure for all of the breast procedures is included in the procedure.
I could be wrong though.


----------



## SRJONES (Feb 14, 2017)

*Lesion removal*

Have there been changes to CPT code requirements for regular excision of moles etc.? Closure has always in the past been included as these are usually simple closures.


----------



## CodingKing (Feb 14, 2017)

SRJONES said:


> Have there been changes to CPT code requirements for regular excision of moles etc.? Closure has always in the past been included as these are usually simple closures.



Nothing has changed on this front


----------

