Complex Surgical Closure

edited May 2017 in Orthopedics
Good Afternoon,



We have a surgeon that takes an hour when he does his closure of the
surgical site and documents more than 5 layers of suturing and then staples,
and one of our coders is using 13160. We have come across denials with
Orthonet stating 13160 is not documented. We are thinking it might be due to
the description as secondary wound closure? Would there be another code to
use instead?



Thanks for any input

Diane

Comments

  • edited May 2017
    Diane,



    Usually, the closure of the surgical wound is included in the reimbursement
    for the surgical procedure. 13160 is used when the surgeon is closing the
    surgical wound after an infectious breakdown/wound dehiscence and the
    infection is cleared up and skin can now be closed. You wouldn't use 13160
    for the primary closure of a surgical incision.



    Sandi Hamrick, CPC

    Toledo Orthopaedic Surgeons
  • edited May 2017
    Hi Sandi,



    Yes I did explain that to her and stressed it to the surgeon but she was not
    sure if anyone ran into the same scenario as well and wanted me to run this
    by.



    Thanks Sandi
  • edited May 2017
    The only thing you could do is possibly use the 22 modifier, however, if he
    routinely takes that long to close all his surgeries, the 22 modifier
    wouldn't work either. 
  • edited May 2017
    Yes I agree and I suggested the modifier 22.



    Thanks
  • edited May 2017
    use modifier -22 for the actual procedure...not the wound closure
    code....with the notes stating why the procedure was longer then
    normal....ie: extensive closure time

    Sincerely,

    Marla
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