Ob-Gyn Coding Alert

Question: How should I code for the repair of a ruptured abdominal wound (in the post-op period)? When the patient was returned to surgery, the physician discovered that her intestine had adhered in the subcutaneous tissue, the suture was intact, but the fascia on the left side of the incision was shredded. Extensive adhesions were taken down, and a piece of Seprafilm was used to keep the bowel from adhering to the abdominal wall or wound again. Multiple drains were placed, and the wound loosely closed. How should I code for all this extra work?

Illinois Subscriber

Answer: Codes 13160 (Secondary closure of surgical wound dehiscence, extensive or complicated) and 49900 (Suture, secondary, of abdominal wall for evisceration or dehiscence) both describe secondary closure of wounds. But in this case, more extensive work was done than just complex skin closure.

Code 13160 more frequently is used for secondary closure after an infectious breakdown of the incision site and usually involves debridement with skin closure. In your case, the incision ruptured, and the surgeon had to open the entire incision, remove the original sutures and take down the adhesions that had created the problem. Because this represents more significant work, 49900 is the best fit.