Whitman Patch Cpt Code

Whitman Patch Cpt Code 10
Cpt Code Lookup

Placement of mesh (49568) is an add-on code for incisional or ventral hernia repairs, performed via an open approach. The range of codes that CPT ® code 49568 may be reported with is 6. The facility may bill for mesh in other cases, but there is not a separate physician charge. Hospital billing codes were reviewed to identify those patients who underwent Wittmann patch placement. Cpt For Whitman Patch. Exp Lap with placement of the Wittmann patch I can use 4. Advancement of the patch basically pulling it tighter 3. Examples of Wittmann Patch being used to treat and close abdominal wounds, as described in the clinical.

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]). It consists of a sterile hook and a sterile loop sheet made from propylene and nylon.

History[edit]

The Wittmann Patch was invented by Dietmar H. Wittmann in 1987 while he was a Professor of Surgery at the University of Hamburg's School of Medicine in Hamburg Germany. Wittmann continued research on the Wittmann Patch fascia prosthesis in the Department of Surgery at the Medical College of Wisconsin. The fascia prosthesis became commercially available in Europe in 1992 (HIDIH-Surgical) and in the US in 2000 (Starsurgical, Inc).

Synonyms[edit]

Fascia Prosthesis,
Abdominal Fascia Prosthesis,
Temporary Abdominal Fascia Prosthesis,
Artificial Bur,
Bur Patch,
Abdominal Bur Closure (ABC-Patch)

Trade names[edit]

Wittmann Patch (Starsurgical, Inc., Burlington WI)

Indications[edit]

A Acute conditions

Abdominal compartment syndrome^[1]
Penetrating abdominal trauma
Traumatic and non-traumatic intra-abdominal hemorrhage
Ruptured abdominal aortic aneurysm
Peritonitis / intra-abdominal infections
Acute pancreatitis / infected pancreatic necrosis

B Chronic conditions

Chronic open abdomen with fistulas
Chronic open abdomen without fistulas
Large ventral hernias with fistulas
Large ventral hernias without fistulas
Failed ventral hernia repairs with meshes

C Prophylactically to avoid abdominal compartment syndrome

excessive peritoneal inflammation from abdominal organ transplantation
excessive peritoneal inflammation from major abdominal operations

Contraindications[edit]

The patch is not intended for permanent implantation.

Operative technique[edit]

The original bur as used by Wittmann consists of two sheets of the same size of 40 × 20 cm:

A softer loop sheet that that covers omentum with its tissue friendly back side – loops facing outwards
A harder hook sheet on top of the loop sheet – hooks facing inwards to be pressed into the loops

The softer loop sheet is sutured to the right fascia using a running looped #1 Nylon suture. The stitches are 2 cm apart and 2 cm into the fascia and 1–2 cm into the bur to permit good perfusion between stitches. The sheet with loops facing outwards is then pushed between parietal and visceral peritoneum of the other side of the incision covering abdominal content.

Whitman Patch Cpt Code 10

Then the harder hook sheet is similarly sutured to the left fascia, and hooks are gently pressed into the loops of the loop sheet.

Generally the hook sheet is trimmed to fit the size of the open abdomen wound. In case of the massive peritoneal hypertension both sheets cover the open space and the hook sheet does not need trimming to fit the wound opening.

Clinical benefits[edit]

Use of the Wittmann Patch in patients allows for a significantly increased rate of delayed primary fascial closure after temporary abdominal closure when compared with a vacuum only closure or the use of a Bogota bag.^[2]
Use of the Wittmann Patch in combination with staged abdominal repair decreases mortality by 20% in patients with APACHE-II score of 20.^[3]

References[edit]

^Stawicki SP, Cipolla J, Bria C (2007). 'Comparison of open abdomens in non-trauma and trauma patients: A retrospective study'. OPUS 12 Scientist. 1 (1): 1–8.
^Boele Van Hensbroek, P; Wind, J; Dijkgraaf, MG; Busch, OR; Carel Goslings, J (2009). 'Temporary closure of the open abdomen: A systematic review on delayed primary fascial closure in patients with an open abdomen'. World Journal of Surgery. 33 (2): 199–207. doi:10.1007/s00268-008-9867-3. PMC3259401. PMID19089494.
^European Journal of Surgery. 25: 273–84. 1994.Missing or empty |title= (help)^{[verification needed]}

Wittmann, DH, Bansal, N, et al. (1994). 'Staged abdominal repair compares favorably with conventional operative therapy for intra-abdominal infections when adjusting for prognostic factors with a logistic model'. Theoretical Journal of Surgery. 9: 201–207. (now Brit J. Surg.)

External links[edit]

Retrieved from 'https://en.wikipedia.org/w/index.php?title=Wittmann_Patch&oldid=999565007'

An abdominal hernia is a protrusion of part of the intestines through a weakened section of the abdominal cavity; herniations can occur in other parts of the body, such as muscle herniations. This article addresses abdominal hernias.

Surgery is directed at permanently closing off the orifice through which the abdominal structures protrude. Sometimes, the hernia can be manually reduced, but this is not a permanent intervention. There isn’t a code for medical reduction of a hernia, it is part of an E/M service.

Codes in the abdominal repair section of CPT^® (49491—49659) are categorized primarily by the type of hernia being repaired, location and the approach (open vs laparoscopic).

Some are further defined as initial or recurrent, depending on whether or not the hernia has required prior surgical repair. Some hernia repair codes are based on the age of the patient, and some are based on the clinical presentation, reducible versus incarcerated or strangulated.

The last update in hernia coding was in 2009. So, if you are an experienced general surgery coder, you can skip this article. If you are new to general surgery coding, read on.

Placement of mesh (49568) is an add-on code for incisional or ventral hernia repairs, performed via an open approach. The range of codes that CPT^® code 49568 may be reported with is 49560—49566. The facility may bill for mesh in other cases, but there is not a separate physician charge.

Remember, you may only report code +49568 only with an open incisional or ventral hernia

Append modifier 50, when appropriate for bilateral hernia repairs, via the same approach for the same type of condition (e.g. bilateral recurrent inguinal hernias, bilateral initial hernias). Do not append a modifier 50 to a right initial inguinal hernia and a recurrent left inguinal hernia, both repaired via the same approach.
If either an incisional or ventral hernia repair is done at the time of another abdominal procedure, through the same incision, do not separately report the hernia repair. It is considered inclusive of the other procedure.
The open hernia repair codes are found in the range of codes 49491-49611
The laparoscopic codes are found in the CPT^® range of codes, 49650-49657
CPT^® code 49659, unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy is reported when a CPT^® code does not exist for the type of repair performed.

Best way to convert your JPG to ICO file in seconds. 100% free, secure and easy to use! Convertio — advanced online tool that solving any problems with any files. Free ico converter download.

Cpt Code Lookup

Don’t have a login? Become a member, or learn more about the benefits of membership by clicking on the link below.

Get Unlimited Access to CodingIntel’s Online Library

Are you a coder, biller, administrator,
office manager or physician?

Learn more about the benefits of
a CodingIntel membership

Loadingdad902