General Surgery Coding Alert

Question:  How should I code this case involving an injury from a motorcycle accident? The documentation reads: “Using #1 PDS suture, we repaired tears of the rectus abdominis into the deep fascia in the anterior abdominal wall. The bladder was protected throughout the dissection and repair. We proceeded with closure performing interrupted closure of the rectus abdominis and fascia in the midline with interrupted figure of eight sutures and then also a running #1 Vicryl to augment the closure. Then #1 Vicryl suture was utilized to close the deep subcutaneous dead space. Subcutaneous closure was performed for superficial subcutaneous closure and subcuticular closure. Dermabond was used and nylon sutures to close around the external fixation pin sites.”

Ohio Subscriber

Answer:  The best code for this procedure would probably be 49900 (Suture, secondary, of abdominal wall for evisceration or dehiscence), although a more complete description of the injury would make this easier to code.

If this code doesn’t seem appropriate to the physician, then you might suggest unlisted abdominal wall code 22999 (Unlisted procedure, abdomen, musculoskeletal system). 

For pricing, you might compare the unlisted procedure code to 49900 or an appropriate hernia repair code (based on location). Both hernia repairs and 49900 involve repairing the abdominal wall, so they should accurately represent pricing for the procedure you describe.