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E. maria Posted Tue 10th of May, 2011 20:03:11 PM

Need help with coding the following:

Patient was brought to operating room, place in supine posistion. Anesthesia was administered generally without difficulty. Patient was prepped and draped in the usual sterile fashion over the anterior abdomen. The previous vertical incision was reopened. There was inflammatory change. The subcutaneous tissued were dissected carefully using electrocautery. There was a small pocket noted in the anterior surface secondary to inflammatory change. Multiple attempts were made to enter the site of the mesh from above the middle and below. Finally, the cavity was entered in the midportion of mesh, anaerobic and aerobic cultures were sent. The dual mesh was surrounded in pus. It was removed, sent to pathology for tissue culture as well. Copious irrigation was done in the abdomen. There was peel noted on the anterior surface of the abdomen. This was not removed secondary to the anticoagulation and significant inflammatory change. At this point, decision was made not to place any Alloderm with concern of infection into this area and the incison was closed using #1 nylon retention sutures and 0-looped PDS running suture for the fascia. Skin was left open and packed with a dressing. CPT 11008 for the removal of mesh, but uncertain as to primary code since 11008 is an add-on code.

Nikhil Answered Tue 10th of May, 2011 21:45:38 PM

The Primary Code: 10180

E. maria Posted Tue 10th of May, 2011 22:09:09 PM

Thank you!

Kim Answered Fri 13th of May, 2011 15:52:39 PM

Our coders use CPT 20525 (Removal of foreign body in muscle or tendon sheath, deep or complicated). We also use ICD 996.69 (infection/inflammatory reaction due to mesh.) Reimbursement is much better than CPT 10180.

SuperCoder Answered Fri 13th of May, 2011 18:43:28 PM

I agree with coding for 11008 [Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary procedure)]
The List of Primary Codes allowed for 11008 are: 10180, 11004, 11005, 11006
The only primary code applicable in this context is: 10180.
Reimbursement is not the criteria to define correct coding. So, if you have coded 20525, please consider these things:
1. This surgery CPT 20525 is not an Add On code for 11008 which is the correct code for the said procedure.
2. The depth here not documented as in "muscle or tendon sheath".

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