AAPC - Back to school
Results 1 to 3 of 3

Thread: Intra-Abdominal Abscess and Necrotic Anterior Abdomen

  1. #1

    Cool Intra-Abdominal Abscess and Necrotic Anterior Abdomen

    AAPC: Back to School
    I need help with coding this Op Report:

    I opened the anterior fascia and a large amount of purulent fluid was encountered. We cultured this and removed the rest of the fluid. I then opened the posterior fascia. The small bowell was adherent to the intra-abdominal wall. This was taken down bluntly and there were wispy adhesions.
    I placed the Bookwalter for visualization. I ran the small bowel beginning at the ligament of Treitz. There was adhesions that were taken down sequentially to visualize the entire bowel. In the mid jejunum, the bowel was stuck to the right abdominal wall, near where the abscess was. This was taken down with Metzenbaum scissors. There was a small enterotomy there, which drained into the abscess cavity.
    We removed all the fluid from the abscess cavity. I continued to run the small bowel. There was only one injury noted. I did create one serosal tear while freeing the small bowel from the abdominal wall. This was oversewn with interrupted3-0 silk lembert sutures. I inspected the colon in its entirety. There were no injured noted. there was some fluid down in the pelvis, but it did not appear infected.
    We located the portion of the bowel that has hole in it. I made a mesenteric defect proximal and distal to this. The bowel was divided with a blue load GIA staplers. I approximated the small bowel with 3-0 sutures. I then divided the mesentery between hemostats and tied this off with 2-0 silk. I then made an enterotomy in both the proximal and distal limb. I placed the 55 blue load GIA stapler. The small bowel was anastomosed in a side to side fashion. I removed the stapler and inspected the staple line. There was no bleeding.
    I addressed the abscess above the liver. I opened the abscess cavity completely. There was succus and there is several pieces of particular matter. We irrigated this out aggressively. In mobilizing the liver, a small tear in the left lobe was created. This was cauterized for good hemostatsis. The liver was adhesed to the anterior wall of the stomach. We bluntly dissected that. There was no apparent infection in the left upper quadrant. We irrigated the abdomen with approximately 6L of saline until it returned clear. Re-addressing the anterior abdominal wall, part of the rectus sheath was necrotic bilateraly (230 sq cm ) this was sharply removed. I also removed more of the soft tissued that was necotric. This was unable to be closed as the fascia was not very health and there is a large defect in the lower abdomen.

    Here are codes that I have come up with:
    44005 -- Adhesions
    44120 -- Small stomach resection with anastomosis
    44604 -- Serosal Tears
    47350 -- Liver Tear
    47010 -- Liver Abscess

    Please Advise // I know there are still codes that I am missing especially removing the Necrotic Skin

  2. #2
    Join Date
    Apr 2007


    This is what I would code, no more no less. If the surgeon documents time spend on LOA, you can add a mod 22 on primary CPT. Also you cannot code for iatrogenic injuries. Also, you should refer to NCCI documents and CCI bundling edits.



  3. #3


    thanks for your help with the coding -- this is very helpful to me.

Similar Threads

  1. Replies: 3
    Last Post: 11-06-2014, 01:15 PM
  2. intra-abdominal abscess
    By NJcoder in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 10-10-2014, 12:23 PM
  3. intra abdominal inf
    By littlec1963 in forum Diagnosis Coding
    Replies: 2
    Last Post: 07-31-2013, 10:55 AM
  4. Help with drainage of pelvic intra abdominal abscess
    By DebbiePottsEngland in forum General Surgery
    Replies: 1
    Last Post: 07-07-2011, 10:27 AM
  5. intra-abdominal abscess
    By NJcoder in forum Diagnosis Coding
    Replies: 1
    Last Post: 08-19-2009, 03:50 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?


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.