Help with OP CPT 49900 and 15777?

ksrkelly7

Networker
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Location
Ventura, California
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Hi there....any help with this OP report would be greatly appreciated! Not sure if I can bill 49900 with 15777.....thoughts?



Indication for Surgery
Spontaneous evisceration status post ex-lap

Preoperative Diagnosis
Same

Postoperative Diagnosis
Same

Operation
Reexploration of laparotomy
Reconstruction of abdominal domain with biological mesh


Anesthesia
Gen. endotracheal anesthesia

Estimated Blood Loss
Minimal

Urine Output
Not applicable

Findings
Complete dehiscence of the fascial plane. Prolene sutures torn through fascia. No evidence of enterotomies

Specimen(s)
None

Complications
None

Technique
This is a very unfortunate 64-year-old gentleman well-known to the surgical service. Patient had a coughing spell this afternoon and felt a pop of his abdomen. On examination the patient had a complete evisceration and fascial dehiscence. Patient was taken urgently to the operative theater placed in supine position surgical timeout was done to identify patient location as well as operation to be performed. Intubated and prepped and draped in a standard surgical fashion. The previous suture was removed the retention suture was removed. The bowel was then carefully dissected off the fascial edges. Copious irrigation was used a 30 x 12 cm biological mesh was then placed underneath the fascial plane and sutured to the anterior abdominal wall using a parachute technique 6 sutures were used total. We had a minimum of 2 cm coverage throughout the whole fascial plane. 10 mL of a cell powder was applied to the logical mesh anteriorly. This was covered by Xeroform. And a wound VAC was then applied over the mesh. Sponge and needle counts correct ×2. The patient will remain intubated for postoperative recovery.



Kelly - CPC
 
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811
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Have you considered 49002 Reopening of recent laparotomy instead of 49900? I only ask because it seems that there was substantially more work involved than would be captured in 49900. If the surgeon had only "put things back together" and resutured an original incision (49900), that'd be one thing. But the op note discusses removal of the old sutures, exploration to make sure there were no other problems, and so forth, which to me qualifies for 49002. I also checked the edits and didn't get anything for 49002 with 15777.
[49900 has about 23.50 RVUs, 49002 has 30 RVUs and obviously higher reimbursement]

Also, are you considering billing for the wound vac? Thoughts?:confused:
 
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