Urology Coding Alert

Reader Questions:

Puzzle Out This Closure Problem

Question: The patient had Fournier’s gangrene wounds. After informed consent was signed, the patient was brought to the operating room. General anesthesia was induced. The patient was placed in the dorsal lithotomy position, the wound VAC was removed, and the patient was prepped and draped in the usual sterile fashion. Time-out was performed. The wound measured 12x7 cm and inspection of the wound showed no evidence of necrotic tissue. There was good granulation tissue present in the wound. The procedure began with extensive irrigation of the wound with antibiotic irrigation. A Penrose drain was placed 2 cm superior to the upper limit of the wound and was placed in the bed of the wound. The drain was secured using 2-0 Vicryl sutures in interrupted fashion for the deeper layers and then 2-0 nylon sutures using a combination of horizontal mattress and interrupted sutures to reapproximate the skin. Some areas of the skin needed to be excised to better reapproximate the skin’s edges. The wound was loosely approximated to prevent putting on tension as well as to allow evacuation of fluid buildup or infection if it developed. Which code should I report for this?

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Answer: You should report 13160 (Secondary closure of surgical wound or dehiscence, extensive or complicated) for your wound closure since your urologist performed a complex wound closure. On the other hand, if your urologist had performed packing or a simple secondary wound closure, you should look to codes 12020 (Treatment of superficial wound dehiscence; simple closure) and 12021 (… with packing).

Don’t miss: You should never report 13160 in conjunction with code 11960 (Insertion of tissue expander(s) for other than breast, including subsequent expansion).

Note that the treatment codes for Fournier’s gangrene (11004 to 11006) have zero- (0-) day globals. Therefore, the above codes do not require a necessary modifier even when billed in the postoperative period.