Wiki Delayed closure for laparotomy

deefarley

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If doctor performed a laparotomy, with small bowel resection, leaving the abdomen open, and returned to close it 2 days later, should I use cpt 49900 or 13160? There was no necrotic tissue debridement. He simply removed the wound VAC and sutured the abdomen.

"After informed consent was obtained, the patient was taken to the operating room, placed in supine position, at which time general anesthesia was induced. Preoperative antibiotics were administered and SCDs were applied. Abthera was removed and abdomen was inspected. Anastomosis was intact with good peristalsis was observed. No other abnormalities found in abdomen, thus I decided to close the abdomen. The fascia was closed with running looped 0-PDS suture. The incision was then closed with staples with Telfa wicks. The patient tolerated the procedure well, was extubated and taken to ICU in stable condition. All needle, lap, sponge counts were correct at the end of the procedure. I was present and scrubbed for the entire case."

Any insights? Thank you.
 
I would be inclined to use an unlisted code for this (e.g. 22999), with a modifier 58. 49900 and 13160 are for closures of a wound dehiscence, which isn't the case here since the wound was never previously closed.
 
I always thought 13160 was for delayed closure also, since the description says secondary closure of surgical wound or dehiscence.
 
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