The Wittmann Patch is a temporary abdominal fascia prosthesis for the planned open abdomen to ease management of cases where the abdomen cannot be closed due to abdominal compartment syndrome or because multiple further operations are planned (damage control repair [DCR]). The Wittmann Patch is also added to negative pressure dressing systems when these systems alone are not enough to achieve fascial closure. The Wittmann Patch helps prevent lateral retraction and maintain abdominal domain. As swelling decreases, the fascial edges are gradually pulled together at dressing changes until able to close.

Question: On several occasions, our surgeons have performed bowel surgery and have had to leave the abdomen open due to edema, etc. Several days later, the surgeon will return to the OR and place a Wittman patch on the abdomen. The surgeon might go back, still later during the same hospital stay, to close the abdomen. How should I code for these? Pennsylvania Subscriber Answer: Initially, you should code the bowel surgery as usual, but append modifier -52 (Reduced services) to indicate that the surgeon did not perform the closure (which is an integral part of all open surgical procedures). Adding modifier -52 will not usually affect your reimbursement, but this does 'leave the door open' for a later procedure to close the abdomen. Coding for the Wittman patch depends on what, exactly, the surgeon did.

For example, the surgeon may sew in a zipper for easy reopening of the abdomen. This will usually also include an exploration and perhaps lavage before he adds the temporary closure (whether a Wittman patch or a zipper). For this, you should report 49002-58-52 (Reopening of recent laparotomy; Staged or related procedure or service by the same physician during the postoperative period; Reduced services). If the surgeon places the patch without abdominal exploration, you should look instead to an appropriate integumentary system closure code (for instance, 13160, Secondary closure of surgical wound or dehiscence, extensive or complicated), with modifier -58 appended.

In this case, as in the above case, the presence of modifier -58 tells the payer that the surgeon planned prospectively for the wound closure. For the final closure, you should once again choose between 49002-58 for closure with exploration, lavage, etc., or 13160-58 for the closure alone with no exploration or lavage.

Abstract Open abdomen (OA) has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. Free install ipx protocol windows 10 and software 2016. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use.

The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient’s physiological condition allows.