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Scar revision/exploration-whose code is correct?

  1. #1
    Default Scar revision/exploration-whose code is correct?
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    I have conflicting codes for this procedure:
    Post-op diagnosis: S/P patellar tendon repair w/ MRSA infection and wound dehiscence.

    Operation: Scar revision and exploration.
    Anesthesia: General

    After elevating the leg for several mintues, the pneumatic tourniquet was elevated to 350 mmHg. The entire incision was utilized. Up near the top there was an area of wound breakdown which was ellipsed from the wound. There was a very difficult time encountered delineating the subcutaneous tissues from the patellar tendon. To the best of our ability, we did so in achieving our wide margins. The area of major wound breakdown was noted to be in the vicinity of one of the FiberWire suture knots. We were able to identify this and remove it in its entirety. In the area where the other area of wound breakdown had occurred, we did encounter two loose strands of the FiberWire suture which were easily removed. Carefully exploring the tendon, no other visible suture was noted. We irrigated the wound with 3 liters of plain saline utilizing a pulsatile lavage. We then explored the wound further near the superior pole of the patella. There was another area that was felt to be consistent with a knot that we did remove both sharply and bluntly. This did not in any way alter the integrity of our repair. The wound was lavaged with a further 3 liters of the plain saline. The subcutaneous tissues were lightly approximated with #3-0 Vicryl. The skin was closed with #3-0 Prolene in simple and in mattress fashion. The wound was then dressed with Betandine-impregnated Adaptic and a bulky compressive dressing. The tourniquet was let down after 64 minutes. The patient was brought out of general anesthesia and returned to the recovery room having tolerated the procedure well.

    We are the payer--when authorization was requested they listed 11406 as the planned procedure. The hospital billed 10121. The surgeon billed 27301. Are any of these right, and would 12020 possibly apply?

    Any help would be appreciated!

  2. #2
    Location
    Milwaukee WI
    Posts
    4,466
    Default Not my specialty ... but
    I'm not an ortho specilist ... but

    I think the hospital is on the right track with 10121, but that seems a little weak given the amont of work done here. He comments on the difficulty delineating the subcutaneous tissues from the patellar tendon., which certainly qualifies for "complicated." On the other hand there were multiple sutures that needed to be removed.

    I think the surgeon's code for 27301 is close but no cigar as well. There is no documentation of an abscess. He even titles his report "scar revision and exploration" He would have to amend his op note to clarify.

    Complex repair - 13120 to 13122 - may be the best option, although he doesn't mention the length of the wound, and you'd need that to correctly code it. Again, he'd have to amend his op note to clarify.

    11406 for the lesion removal (i.e. a simple scar revision) was completely wrong for a pre-auth ... but perhaps his office staff didn't know about the deep infection when they sought the pre-auth.

    12020 is also incorrect because it is for a simply closure of a wound dehiscence ... the surgeon cleans the open edges and sutures it. This was MUCH more work.


    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  3. #3
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by FTessaBartels View Post
    I'm not an ortho specilist ... but

    I think the hospital is on the right track with 10121, but that seems a little weak given the amont of work done here. He comments on the difficulty delineating the subcutaneous tissues from the patellar tendon., which certainly qualifies for "complicated." On the other hand there were multiple sutures that needed to be removed.

    I think the surgeon's code for 27301 is close but no cigar as well. There is no documentation of an abscess. He even titles his report "scar revision and exploration" He would have to amend his op note to clarify.

    Complex repair - 13120 to 13122 - may be the best option, although he doesn't mention the length of the wound, and you'd need that to correctly code it. Again, he'd have to amend his op note to clarify.

    11406 for the lesion removal (i.e. a simple scar revision) was completely wrong for a pre-auth ... but perhaps his office staff didn't know about the deep infection when they sought the pre-auth.

    12020 is also incorrect because it is for a simply closure of a wound dehiscence ... the surgeon cleans the open edges and sutures it. This was MUCH more work.


    Hope that helps.

    F Tessa Bartels, CPC, CEMC
    I concur with your evaluation of the codes! Maybe they could use modifier 22 on the 10121to indicate the additional work?
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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