Neurosurgery Coding Alert

Question: I would appreciate help coding the following procedure: Procedure:

1. Right-sided scalp wound revision & debridement of necrotic scalp tissue.

2. Closure of complex wound.

Indications:

Patient underwent a right-sided craniectomy for malignant cerebral edema & transient ischemic stroke with failure of the wound to heal. Because of concerns that the patient may develop a further super infection, he was taken to the operating room at this time.

Description of Procedure:

After ascertaining the correct patient & induction of general anesthesia, a surgical time out was performed in the room by the members of the surgical team. Once this was done, the area of the previous incision was reopened with a combination of a #10 blade & monopolar electrocautery. Dissection continued through the cortical galeal adhesions. No purulent material was found, although some necrotic skin edges were actually found. These were debrided & removed with the use of tenotomy scissors.

Further dissection & removal of the cortical galeal adhesions revealed no evidence of any abscess. Copious amounts of Bacitracin irrigating solution were used to irrigate the overlying cortex as well as scalp. Bleeding points were controlled with bipolar electrocautery. Surgical was placed over the galea, and after this was done closure began by approximating the galea with 2-0 Vicryl & the skin with 0-Prolene in a vertical mattress fashion. Prior to closure, a Hemovac drain was placed.

New York Subscriber

Answer: Although treatment of a postoperative wound infection other than a subfascial spinal infection is typically reported with 10180, the scenario described did not identify an infection but rather involved a tissue debridement followed by secondary closure of a surgical wound. The debridement is reported with one of the 11040-11044 series of debridement codes (depending on the extent of tissue(s) resected) appended with the -51 multiple procedure modifier. The subsequent closure described would be reported with 13160. Both codes would be appended with the -78 modifier if the wound debridement and repair are performed within the 90 day global period of the craniectomy.