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wound washout s/p exp lap

  1. #11
    Milwaukee WI
    Default 10180 vs 97605/06
    Medical Coding Books
    The following descriptions are from Encoder Pro

    10180 - This procedure treats an infected postoperative wound. A more complex than usual incision and drainage procedure is necessary to remove the fluid and allow the surgical wound to heal. The physician first removes the surgical sutures or staples and/or makes additional incisions into the skin. The wound is drained of infected fluid. Any necrotic tissue is removed from the surgical site and the wound is irrigated. The wound may be sutured closed or packed open with gauze to allow additional drainage. If closed, the surgical site may have suction or latex drains placed into the wound. If packed open, the wound may be sutured again during a later procedure. (emphasis added by FTB)

    11005- Debridement is carried out for a severe type of tissue infection that causes gangrenous changes, systemic disease, and tissue death. These types of infections are caused by virulent strains of bacteria, such as "flesh-eating" streptococcus, and affect the skin, subcutaneous fat, muscle tissue, and muscle fascia. Surgery is performed immediately upon diagnosis to open and drain the infected area, excise the dead or necrotic tissue. Report 11005 for the abdominal wall, with or without surgical closure of the abdominal fascia.

    49002 - The physician reopens the incision of a recent laparotomy before the incision has fully healed to control bleeding, remove packing, or drain a postoperative infection.

    HOWEVER -- you mention using wound vac placement, with these repeat washouts (as many as 20 in post op period). I'm wondering if what you should be coding is the wound vac only ... 97605-97606.

    F Tessa Bartels, CPC, CEMC

  2. #12
    Kansas City, MO
    I am having the same issue, so I'm gonna bring this one back did you finally decide to code?

    Tessa, you gave some descriptions of some "skin" codes. Are these appropriate seeing as how this is really an "internal" thing going on?

    From what I understand of wound vacs, these are not usually billed in these situations. In the stated situtation, they are used for more like a drain.

    I thought about 49002 as well....but there is no 're-opening' when the wound is left open each time.

    This is starting to drive me crazy!

    Im thinking of going unlisted, or doing the 49002-52...this would just get cumbersome with so many operations which equals lots of paper claims with attachments if I use those.


    Linda Vargas, CPC, CPCO, CPMA, CPC-I, CEMC,CCC, AAPC Fellow
    PMCC Licensed Instructor
    2018 Chapter President, Kansas City, MO

  3. Default
    How about 15852-58? You have to do this under anesthesia and it states for "other than burns." You could argue 49002-58 too if depth of washout is to fascia and again under anesthesia. However, I think in this scenario 15852 may be more accurate. We use 49002 to report re-exploration in recent laparotomies when we are trying to determine the cause of a developing symptom or possible complication.

    Anna Barnes, CPC, CEMC

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