General Surgery Coding Alert

You can report 49002 when the surgeon reopens the wound

If your surgeon is re-exploring an abdominal wound with washing and VAC (vacuum-assisted closure) placement, don't just bill for abdominal lavage--or you could be throwing away hundreds of dollars.

Let our experts advise you on the right way to report these procedures.

Watch the Op Note Carefully

Keep a close eye on the body of your surgeon's operative report: Surgeons sometimes fail to document their work properly when they reopen an abdominal wound, says Christine Endes, surgical coding specialist at Einstein Healthcare Network in Philadelphia. As a result, coders could mistakenly report peritoneal lavage 49080 (Peritoneocentesis, abdominal paracentesis, or peritoneal lavage [diagnostic or therapeutic]; initial) when they should claim 49002 (Reopening of recent laparotomy), she says.

Example: A trauma surgeon has closed the wound previously, but the surgeon reopens the stitches and moves some organs out of the way to examine the progress of healing. The surgeon inserts a hose to clean out the wound and then applies vacuum-assisted wound drainage before closing the wound again. The surgeon may make the mistake of simply recording -abdominal washout- or -abdominal cleanout,- Endes says.

Why you should be concerned: Medicare pays about  $80 for peritoneal lavage, but it pays between $600 and $700 for reopening a recent laparotomy, Endes says. And because some patients may go back as many as 10 times for re-exploration, it pays to bill correctly.

Warning: The surgeon must document in detail what she found after reopening the wound, Endes says. Make sure the documentation mentions checking the valve for leaks and performing the saline wash.

-Reopen- Provides Clues

Look at the big picture when reading the op report, says Nancy L. Reading, RN, BS, CEO of CedarEdge Medical in Draper, Utah. Generally, the surgeon couldn't have performed lavage without reopening the wound.

Surgeons may encourage you to undercode because they-re worried they won't receive any payment for re-exploring the wound if it happens during the global period after the original surgery, Reading says.

But Endes says you should be able to bill for 49002, using modifier 78 (Return to the operating room for a related procedure during the postoperative period), for a return to the operating room for a related procedure.

Sometime bonus: On occasion, Endes has been able to bill 97605 (Negative pressure wound therapy [e.g., vacuum-assisted drainage collection], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session; total wound[s] surface area less than or equal to 50 square centimeters) and 97606 (... total wound[s] surface area greater than 50 square centimeters) for the vacuum-assisted wound drainage collection in addition to 49002-78. Medicare hasn't assigned any RVUs to 97605-97606 (and therefore will not pay for them), but some other payers will reimburse.