Wiki Infected Mesh Removal

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sadieandbrian

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Can anyone guide me on a code for excision of infected mesh? My physician documented it as CPT 11008, however this is an add-on code. When I brought up that we need to also bill 11004-11006 (in this case 11005), he said "I thought about using that CPT code but it was not a necrotizing soft tissue infection. Most mesh removals are not for necrotizing infection but rather an infected mesh that cannot be sterilized with antibiotics."

I am not coming up with any other alternatives.
Diagnosis: Infected mesh, anterior abdomina wall from epigastrium to symphysis pubis.
Procedure: Excision of mesh & suture granulomas, midline fascia

Any help would be appreciated, thank you!
 
I believe it is appropriate to use 11005 (if it is just the abdominal area) along with 11008 in the scenario you present. Ingenix General Surgery Coding Companion indicates that the mesh may be removed due to the presence of chronic infection, a necrotizing soft tissue infection, or a mesh infection.

The coding tips indicate that 11008 must be reported with 11004-11006 because the soft tissue infection must also be debrided at the same time as removing the mesh. I don't believe 11004-11006 can only be used to report debridement of necrotizing soft tissue infection because Ingenix indicates that it is for debridement of tissue infection that can cause gangrenous changes, systemic disease, and tissue death.

Some of the ICD-9 codes listed as being applicable are for inflammatory disorders, abscesses, ulceration and are not limited to Necrotizing fasciitis.
 
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