Results 1 to 7 of 7

Thread: Is this closure billable?

  1. #1
    Join Date
    Apr 2007
    Location
    Lehigh Valley
    Posts
    174

    Default Is this closure billable?

    Promo: Code Books
    Hello,

    My DR performed an umbilical hernia repair which was incarcerated. He wants to bill out a first-degree closure which involved Ethibond pop-off sutures tranversely, two figure of eight sutures transversely and the umbilical stalk base was pexied to the fascial closure using 3-0 Vicryl. The deep subcu tissues were reapproximated to prevent seroma formation using 3-0 Vicryl in an interuppted fashion.

    Can this be billed out or all major surgeries repair included? If it can, which repair code would this fall under?

    Thanks fo the help!

  2. #2
    Join Date
    Apr 2007
    Location
    Milwaukee WI
    Posts
    4,451

    Default Closure included in surgery procedures

    With the EXCEPTION of lesion excisions (integumentary section ONLY) that require more than a simple closure, all surgical procedures INCLUDE the closure of the wound. Not separately billable.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Join Date
    Apr 2007
    Location
    Lehigh Valley
    Posts
    174

    Default

    Thanks Tessa!

    That's what I thought, but I wanted to be sure.

  4. #4

    Default

    Quote Originally Posted by FTessaBartels View Post
    With the EXCEPTION of lesion excisions (integumentary section ONLY) that require more than a simple closure, all surgical procedures INCLUDE the closure of the wound. Not separately billable.

    F Tessa Bartels, CPC, CEMC
    This is exactly what I have been explaining the surgeon I work for, but I cannot find it in writing. Can you tell me where I can find this in writing so that I can present it to him? Thanks!

  5. #5

    Default

    Tessa,
    An excision of breast lesion identified by preoperative placement of radiological marker; single lesion was performed. Would this code (19125) also include wound closure of tissue defect or can it be coded separately and do we have the appropriate documentation to code wound closure size?

    See below:
    The left breast was prepped and draped in the usual sterile fashion after the wire was trimmed to about 5 centimeters from the skin. outflow. Please note that Venodynes were placed and started before the sedation was begun. The wire exited the skin very laterally. Almost at the anterior axillary line medial to that at approximately the 2:00 axis and 6 is a large hypertrophic scar from the stereotactic biopsy about 5 mm big.

    The incision was made in an elliptical fashion in the circumareolar direction to include this scar in a 4 cm incision. The ellipse of skin with the scar included was sent separately to pathology. Sharp rakes were used to lift the skin and the dissection was carried in the subcutaneous tissue laterally to where the wire entered the skin. The wire was then drawn into the surgical cavity and followed down to where a thick chunk of tissue which was hard and nodular was encountered. This is where the thick portion of the wire passes through and so this entire area was removed. It measures about 4 cm by 2 x 2 centimeter. This was marked with a short stitch superior and a long stitch lateral. The lateral stitch is at the lateral extent of the lesion where the needle exits the skin. This was sent to pathology.

    Because of long distance it took to tunnel from the lateral portion of the breast to this lesion, which was in essence in the midportion of the breast, there was a large tissue defect measuring about 10 cm by 5 x 3. It is raised in a medial to lateral fashion, and so while the tissue defect is there, it closes down easily so I used interrupted Vicryl sutures to reapproximate the deep tissues so that there would be no deformity and once this long tunnel was closed, the skin was closed in multiple layers.

    Once the incision was completely closed, the skin was covered with Steri-Strips, 2 x 2's and Tegaderm.

    The patient tolerated the procedure with no complications and was taken in stable condition to the recovery room.
    Thank you!

  6. #6

    Default

    Does anynone have any thoughts??

  7. #7
    Join Date
    Apr 2007
    Location
    Fayetteville, NC
    Posts
    300

    Default

    In my opinion the closure is included in the procedure Caroline.
    I believe the only codes that you can code a more intensive closure on are the lesion removal integumentary (skin)codes excluding the breast codes. If I remember correctly the closure for all of the breast procedures is included in the procedure.
    I could be wrong though.

Similar Threads

  1. partial closure of incision with ABRA closure device?
    By CoderSB in forum General Surgery
    Replies: 0
    Last Post: 10-23-2013, 02:40 PM
  2. Is this billable
    By sune626 in forum E/M
    Replies: 1
    Last Post: 02-19-2013, 08:57 AM
  3. is this billable
    By sune626 in forum Billing/Reimbursement
    Replies: 0
    Last Post: 02-19-2013, 07:10 AM
  4. Is this billable?
    By coder25 in forum E/M
    Replies: 1
    Last Post: 04-12-2010, 02:36 PM
  5. is this billable?
    By taylov519 in forum E/M
    Replies: 3
    Last Post: 09-29-2009, 11:28 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.