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Component separation technique

  1. #1
    Default Component separation technique
    Medical Coding Books
    Could someone help code the following case:

    Postop Dx: Loss of abdominal domain

    Name of Operation: Component separation technique w/myofascial advancement flap for delayed primary closure of abdominal wound & restoration of abdominal wall anatomy.

    Description of Operation:

    The vacuum assisted closure device was removed. His abdomen was
    inspected, there was no evidence of fistula mesh. The skin edges
    demonstrated good viability with excellent granulation tissue in the
    wound. Its overall appearance was clean. It was irrigated with 5
    liters of normal saline. The stomas were pink & functional. I then
    made the decision to attempt a closure of his abdomen. I did perform a
    further component separation technique with further elevation of his
    rectus muscle & anterior fascia off of the posterior fascia. This was
    carried out laterally approximately 2 to 3 cm beyond the lateral borders
    of the rectus muscle, aside from adjacent to his ileostomy & mucous
    fistula. This was done on both sides of his abdominal wall. I then
    continued further advancement of the skin flaps involving just above the
    anterior fascia. Again, this was carried out approximately 3 to 4 cm
    beyond the lateral borders of his rectus muscle on both sides of his
    abdominal wall. I then created four relaxing incisions of the anterior
    fascia. This was approximately 3 to 4 cm beyond the lateral border of
    the rectus muscle both above & below the stoma sites. This incision was
    made through the returns today for & down through to the muscle. This
    allowed for further advancement of the rectus flaps to be mobilized
    medially for closure. There was an are of exposed bowel with no
    evidence of fistula formation that was imbricated with the biologic mesh
    to allow closure of this. CloSeal was used to cover this to help
    prevent fistula formation in this region. I then placed four 19-French
    Blade drains that lay on both left & right below the posterior fascia &
    below the rectus muscle. These were exteriorized at the inferior
    quadrants of his abdomen & secured to the abdominal wall with the use of
    2-0 nylon. I then placed 2 additional 19-French Blake drains that were
    exteriorized at the superior quadrants of his abdomen. These lay in the
    skin flaps above the rectus muscle & again were secured to the abdominal
    wall with the use of 2-0 nylon.

    I then began a single-layer closure of his abdomen reapproximating the
    fascia just medial from the rectus muscle emcompassing both the anterior
    & posterior portions. This was done from the superior canthus to the
    midline & from the inferior canthus to the midline with the use of #1
    looped PDS with every third throw in a locking fashion. I was able to
    reapproximate this under no tension. I then irrigated the subcutaneous
    tissue, reapproximated the skin flaps that were created with the use of
    3-0 Vicryl in a simple inverted interrupted fashion & skin clips. I
    then placed a bolster incision back directly over the incision line in
    the usual standard fashion, which was hooked to 150 mmHg of pressure
    continuous suction with high intensity. A drape was placed over the
    incision line that was fenestrated right down the middle directly over
    the skin clips & this acted as a bolster incisional VAC, which was
    secure & functional. Appliances were then reapproximated to his
    ileostomy & mucus fistula. The general endotracheal anesthetic was
    reversed, he was transferred off the operative table & to the
    postanesthetic care unit in stable & satisfactory manner.

  2. Default
    CPT 15734 for abdominal componet seperation, use 15734-RT and 15734-LT to indicate both sides were done. I believe you can bill it 15734-50 too, but we bill as a RT and LT. The carriers seem to like it this way. Mesh is included and not billed seperate.

    Anna Barnes, CPC, CGSCS

  3. #3
    Thanks so much for your help.

    Beth Piggott, CPC

  4. #4
    15734 cannot be billed with 50, RT, LT as it is not assigned laterality. You can use 59 or the X_ codes with it. My surgeon insists there is a separate code for component separate besides the 15734. Does anyone know of a separate code? Thanks.

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