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Closure of Abdominal Wall

  1. #1
    Winchester, VA
    Question Closure of Abdominal Wall
    Medical Coding Books
    The patient had a nephrectomy done by Urology but due to the quality of the tissues, the size of the wound (20 cm.), and the multiple risks for a ventral hernia, the nephrologist asked our surgeon to come in and close the abdominal wall.

    What CPT code would I use for this? Complex wound repair? Intermediate wound repair? Is there some other code? Also, would I use -59 modifier on this?

    Any thoughts would be welcomed.

  2. #2
    I would think that you would code the nephrectomy for both physician's and append a modifier 62 for co-surgeons... not positive though.

  3. #3
    Milwaukee WI
    Default Co-surgery
    Sounds like co-surgery to me. You will use the same primary surgical procedure code for both surgeons. Each surgeon will dictate his/her own operative note desciribing the part s/he played in the total procedure. Each should be reimbursed 62.5% of allowable.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

  4. #4
    Winchester, VA
    Default RE: Closure of Abdominal Wall
    I had thought about using the -62 modifier but it just doesn't seem like he's really doing much of the work for the nephrectomy. Here's the surgeon's note:

    PROCEDURE: Closure of abdominal wall.
    INDICATIONS FOR PROCEDURE: The patient is a 49-year-old female who underwent a left nephrectomy by Dr. UROLOGIST. Due to the quality of the tissues and the size of the wound and the multiple risks for a ventral hernia, we were consulted regarding the closure of the wound.
    DESCRIPTION OF PROCEDURE: The patient was already under general anesthesia and had undergone the nephrectomy. The hemostasis was appropriate and we closed the wound in several layers. The peritoneum and transversalis muscle were approximated using a running #1 Vicryl. Then, the internal oblique aponeurosis and the external oblique aponeurosis were closed separately with interrupted #1 PDS sutures in a figure-of-eight fashion. This created a very strong and nice repair. The subcutaneous tissue was approximated with multiple 3-0 Vicryl sutures in an interrupted fashion and then the skin was closed in a subcuticular stitch. The length of the wound was 20 cm. This was closed in layers as stated above.

  5. #5
    Johnson City
    Mod 62 means each surgeon does separate and distinct parts of a surgery. Therefore no worries that your surgeon didn't really do much in regards to the nephrectomy, you surgeon did a distinct part (closing the abdomen).
    Melissa Jewett, CPC

  6. #6
    Winchester, VA
    Default RE: Closure of Abdominal Wall
    Thanks for all the responses! -62 modifier it is!


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