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E. maria Posted 7 Year(s) ago

Need help coding this, the op report is as follows:

Drainage and debridement of infected seroma cavity, removal of infected prosthetic mesh and placement of acellular dermal matrix in onlay fashion

Patient wa moved in to the operating room and placed in supine position. General endotracheal anesthesia was induced. The patient's abdomen was prepped and draped in the usual sterile manner. The previous lower midline incision was opened. Upon entering the subcutaneous tissues, a thick-walled, infected seroma cavity was encountered. Aerobi, anaerobic cultures were obtained. The cavity was extensively debrided of contaminated and necrotic subcutaneous tissue and fat. After this had been adequtely debrided,inspection of the wound revealed the onlay mesh within the infected cavity. At this point the decision was made to remove the infected mesh. As much of the mesh as could possiblu be removed was done so using sharp dissection. After the mesh had been removed, a Zen matrix acellular dermal matrix was chosen and placed overlying the intact mesh in an onlay manner. The mesh was sutured in place using #0 PDS interrupted mattress sutures. The wound was copiously irrigated with sterily saline and carefully instected to ensure adequate hemostasis. A 15-mm Blake drain was placed in the subcutaneous tissues, brought through separate stab wound incisions in the left lower quadrant. The drain was sutured in place using 2-0 silk suture. The subcutaneous tissues were tacked down to the onlay mesh in attempts to obliterate the seroma cavity, using a 2-0 Vicryl interupted sutures. The rest of the subcutaneous tissues wre reapproximated in the midline using 2-0 Vicryl interrupted suture. The skin was closed with skin staples. My doctor wants me to use 15170, 15171 and 11008. I want to use 15330, 15331. and maybe unlisted for the removal of the mesh since CPT 11008 is an add-0n code and needs to be used in conjuction oly with 10180, 11004-11996.

Thank you
Maria Nunez

Nikhil Posted 7 Year(s) ago

Codes: 11005 and 11008

Maarit Posted 7 Year(s) ago

11004 and 11005 are for Dx necrotizing tissue infection only. We had a denial from Medicare for using this CPT with Dx 996.69 and 879.3. If the Dx is post-op wound infection 998.59 you can use 10180 with 11008...But if it is listed as seroma, I believe you would have to use 10140 with 15430/ 15431, if there are no CCI edit conflicts. (I'm not at work, so I cannot verify this). I too wonder if the removal of the old mesh should be reported with an unlisted code, since it was denied on our claim. By the way, is "Zen acellular matrix" derived from human skin? If so, then codes 15170/ 15171 are correct. I hope we get more responses to your posting. Coding grafts is challenging. ag

Maarit Posted 7 Year(s) ago

Maria, please let me know if you have received reimbursement for CPT 15430/ 15431 before...and for what Dx. The denial I refer to in my response was a case where a 3-year-old mesh became infected...and had to be removed. I used Dx 996.69 and 879.3, but 15430 was denied as "wrong Dx". I appreciate your in-put. ag

E. maria Posted 7 Year(s) ago

Anne, I have billed with the CPT code 15330 with dx 996.69 Acellular dermal allograft. Allograft is donated human tissue that works like an autograft. Over time, it regenerates into the the patient's own natural soft tissue. Will let you know if we get paid.

Maria Nunez

Posted by E. maria, 7 Year(s). There are 5 posts. The latest reply is from E. maria.

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