Wiki repair after radical soft tissue resect

[cmartin]

No responses in General Surgery so trying over here in Plastics!
Instructs say simple or intermediate repair included, complex repair or reconstruction to be reported separately. Did radical resect abdominal wall sarcoma (22905). Specimen 18.5 x 12.5 x 9.5 cms (actual tumor 13.5 x 9.4 x 5.8). After removing the specimen: "then separated out the peritoneum from what was left of the abdominal wall muscles on the lateral & superior aspect of the defect, & started closing the defect. We started from the lateral aspect & started approximating the abdominal muscles together. Then as we moved medially we started approximating the abd wall muscles to the periosteum on the ilium bone and we then started #1 PDS from the medial aspect & approx'd the rectus muscle&fascia to the periosteum
and the muscle fascia close to the ilium periosteum. We then left about a 5x5 cm defect. We used a Stratus mesh & we laid it on top of the defect & we sutured the mesh w/a #1 Prolene to run and then anchored the mesh to the muscle & fascia underneath it. We placed it in overlay fashion over the defect. Mesh then anchored to rectus fascia on medial aspect of wound & then to periosteal fascia on posterior & lateral part & then to the abd wall muscles on the superior aspect of the defect. Then raised more flaps on superior aspect of wound & placed 19 J-P in wound above fascia in subq, then approx'd skin edges w/interrupted 3-0 Vicryl & then stapled the skin.
My Question: would you say this repair/reconstruction is separately codeable, & if so, how would you code it?
Thanks to any & all for your opinions!
Connie M (CPC,CGSC)

 

[jackjones62]

Hi Connie, although abdominal surgery is not my specialty, I found your question to be a challenge, so here is my response and hopefully it will illicit a response from someone else either agreeing or disagreeing and providing more coding info....

I read the op note, I started with the code you provided, CPT 22905, Radical resection of tumor, soft tissue of abdominal wall; 5cm or greater....My first observation was there were no parenthetical statements directing you to any other coding scenerios; next, it has been my experience when radical resections are done the closure of the wound is inherent to the code, unless there is reconstruction/repair using specific types of flaps; advancing surrounding skin, tissue & muscle into the wound for closure is not separately billable; I read where your surgeon used mesh in the 5x5 cm defect and began to look under abdominal repair and found this statement: "With the exception of the incisional hernia repairs (see 49560-49566) the use of mesh or other prostheses is not separately reported". So with that statement, my response to you is that you cannot code separately for a reconstruction/repair, this is a wound closure; although you may consider addending a modifier 22 to CPT 22905 for increased procedural servics because the closure was complex and took more time.....just a suggestion.

Hope this helps,

Jennifer
CT ENT