General Surgery Coding Alert

Question: Our surgeon performed a procedure for a patient who had lost considerable weight following bariatric surgery. The patient suffered recurring rashes, sores and infection due to rubbing skin folds. The surgery involved removing skin and fat, performing intermediate and complex closure and plication of the facia to relieve tension, plus repositioning the umbilicus. How should we code this?

Louisiana Subscriber

Answer: The procedure you describe is a panniculectomy, which is surgery to remove excess, loose abdominal skin and fat that may occur following extensive weight loss. The proper code for a panniculectomy is 15830 (Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy).

Because the surgeon also performed fascial plication and repositioning the umbilicus, you should add code +15847 (Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure)).

That’s all: Although you describe specific steps such as intermediate and complex closure or adjacent tissue transfer for the umbilicus repositioning, you should not report additional codes for those steps. The 15830 and +15847 codes encompass those individual steps. In fact, CPT^® text note for 15830 states, “Do not report 15830 in conjunction with 12031-12037, 13100-+13102, 14000, 14001, +14302 for the same wound.”