General Surgery Coding Alert

Question: On several occasions, our surgeons have performed bowel surgery and have had to leave the abdomen open due to edema, etc. Several days later, the surgeon will return to the OR and place a Wittman patch on the abdomen. The surgeon might go back, still later during the same hospital stay, to close the abdomen. How should I code for these?


Pennsylvania Subscriber

Answer: Initially, you should code the bowel surgery as usual, but append modifier -52 (Reduced services) to indicate that the surgeon did not perform the closure (which is an integral part of all open surgical procedures). Adding modifier -52 will not usually affect your reimbursement, but this does "leave the door open" for a later procedure to close the abdomen.

Coding for the Wittman patch depends on what, exactly, the surgeon did. For example, the surgeon may sew in a zipper for easy reopening of the abdomen. This will usually also include an exploration and perhaps lavage before he adds the temporary closure (whether a Wittman patch or a zipper). For this, you should report 49002-58-52 (Reopening of recent laparotomy; Staged or related procedure or service by the same physician during the postoperative period; Reduced services).

If the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code (for instance, 13160, Secondary closure of surgical wound or dehiscence, extensive or complicated), with modifier -58 appended. In this case, as in the above case, the presence of modifier -58 tells the payer that the surgeon planned prospectively for the wound closure.

For the final closure, you should once again choose between 49002-58 for closure with exploration, lavage, etc., or 13160-58 for the closure alone with no exploration or lavage.