Wiki Abdominal wall nonhealing granuloma

[renee.lyle]

Patient is status post open gastric bypass 7-8 months ago. Elliptical incision was made with Bovie cautery cut down through skin. The pt had 2 opening in the upper most portion of the incision. They were communicating with each other and one appeared to go deep into the abdomen although no evidence of any fistula tract. Once this was excised, it was found that this went down below the level of the fascia. There was no involvement of the small bowel or fistula to the stomach, small bowel, or colon. There was no evidence of any drainage. Once the entire granulomatous tract was excised in its entirety, the fascial defect which was approximately 1 x 2 cm was closed using 2 figure-of-eight # 1 looped PDS. The subcutaneous tissue was closed using a 3-0 Vicryl and the skin was left open.The specimen was sent for pathological eval and the open wound was packed using 1/2 inch plain packing.

Originally this was coded as 49999 and the insurance company is denying because the CPT doesn't match the OP report. My office manager says the code should be 13160. Could someone please help me?

 

[FTessaBartels]

13160

13160 sounds right to me.
The lay description is: The physician secondarily repairs a surgical skin closure after an infectious breakdown of the healing skin. After resolution of the infection, the wound is now ready for closure. The physician uses a scalpel to excise granulation and scar tissue. Skin margins are trimmed to bleeding edges. The wound is sutured in several layers. (From Encoder Pro)

Why did you think unlisted code should be used?

F Tessa Bartels, CPC, CEMC

 

[renee.lyle]

This charge was posted before I started in my current position. I compared it to the hospital charge since it was done as an outpatient procedure and they had it billed as the unlisted procedure also. That is where my confusion came into play. Thank you so much for your help.