Ob-Gyn Coding Alert

Question: My ob-gyn saw a patient with a post-op wound infection following a cesarean delivery. He readmitted the patient to the hospital seven days later and did an exploratory laparotomy with extensive debridement of fascia and subcutaneous tissue. The path report says -focal necrosis.- Since it wasn't necrotizing fasciitis, I can't use 11005, can I? Should I use 11042-78? Should I also code the exploratory lap (49002-78) since they opened her up again or is this over-coding?

Connecticut Subscriber

Answer: You can use 11005-78 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure; Unplanned return to the operating/ procedure room by the same physician following an initial procedure for a related procedure during the postoperative period). Focal necrosis would require the same amount of work as 11005's definition describes.

Reporting 49002 (Reopening of recent laparotomy),however, in addition would be overkill. Why: Exploration is an integral part of all open surgical procedures.

Assuming the ob-gyn performed the tubal during the same hospital stay, you should report only the abdominal tubal ligation (58600, Ligation or transection of fallopian tube[s], abdominal or vaginal approach, unilateral or bilateral) appended with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period). You would apply modifier 79 because the tubal is unrelated to the performance of the wound debridement.

You will not bill separately for the fascial closure at this session.

For the secondary closure three days later, you should report 13160-58 (Secondary closure of surgical wound or dehiscence, extensive or complicated; Staged or related procedure or service by the same physician during the postoperative period).