maine4me
Guru
I could use some help with this operative report. This was coded as 49560 and 11008 - 51. I do not see a CCI edit for these codes. Medicare denied with a CO107 - The related or qualifying claim/service was not identified on this claim. I am at a loss as to what they are looking for. Is there a different code that should be used in this case, or is the removal of sutures not separately billable. I am also not certain about the 49560, should this be billed as 13160.
PROCEDURE AND FINDINGS: The patient was brought to the Operating Room,
properly identified and placed on the table in supine position. Preop
diagnosis, procedure and site were confirmed on time out. She had Ancef
preop. Sequential TEDS were placed. General anesthesia was induced via IV
and orotracheal tube. The abdomen was first scrubbed with Betadine soap and
then prepped with Betadine and drapes applied. The wounds were probed and
the upper sinus tract superiorly and the lower sinus tract slightly inferior
and medially. The upper one was first opened with an incision going more
superiorly and carried down sharply. Old granulation tissue was encountered
which was excised and then a long piece of Tevdek suture was removed. The
knot was still tied but free, and came out without any problems. The wound
was then gently probed and it was found that there was a fascial defect at
the depth of the wound. This defect was then closed with running 0 Prolene
suture. The wound was thoroughly irrigated. Attention was then turned to the
inferior wound and incision was made from the sinus tract going more medially,
and again, the tract was opened and in the depth of the wound another piece
of Tevdek suture was encountered. This was again removed without having to
cut it. There was possibly a very tiny fascial defect there as well, and
this was closed with a figure-of-eight suture of 0 Prolene. Both wounds were
thoroughly irrigated and no other foreign body was encountered. A culture
was taken of the upper wound. Both wounds then had a 1/4 inch Penrose
placed down to the depth of the wound and this was sutured to the corner of
each incision with 3-0 nylon. Both were injected with 0.25% Marcaine and
then the skin was approximated with vertical mattress sutures of 3-0 nylon.
Dressings were applied. Needle, sponge, and instrument count was correct x2
and blood loss was minimal.
PROCEDURE AND FINDINGS: The patient was brought to the Operating Room,
properly identified and placed on the table in supine position. Preop
diagnosis, procedure and site were confirmed on time out. She had Ancef
preop. Sequential TEDS were placed. General anesthesia was induced via IV
and orotracheal tube. The abdomen was first scrubbed with Betadine soap and
then prepped with Betadine and drapes applied. The wounds were probed and
the upper sinus tract superiorly and the lower sinus tract slightly inferior
and medially. The upper one was first opened with an incision going more
superiorly and carried down sharply. Old granulation tissue was encountered
which was excised and then a long piece of Tevdek suture was removed. The
knot was still tied but free, and came out without any problems. The wound
was then gently probed and it was found that there was a fascial defect at
the depth of the wound. This defect was then closed with running 0 Prolene
suture. The wound was thoroughly irrigated. Attention was then turned to the
inferior wound and incision was made from the sinus tract going more medially,
and again, the tract was opened and in the depth of the wound another piece
of Tevdek suture was encountered. This was again removed without having to
cut it. There was possibly a very tiny fascial defect there as well, and
this was closed with a figure-of-eight suture of 0 Prolene. Both wounds were
thoroughly irrigated and no other foreign body was encountered. A culture
was taken of the upper wound. Both wounds then had a 1/4 inch Penrose
placed down to the depth of the wound and this was sutured to the corner of
each incision with 3-0 nylon. Both were injected with 0.25% Marcaine and
then the skin was approximated with vertical mattress sutures of 3-0 nylon.
Dressings were applied. Needle, sponge, and instrument count was correct x2
and blood loss was minimal.