# Help / trauma / multiple surgeries



## ksrkelly7 (Mar 4, 2015)

I could really use some help.  This patient had 4 surgeries in one day, and 1 two days later.  All with surgeons and assistant surgeons from the same group.  I have attached brief OP notes, not the whole thing.  I am struggling with the modifiers as well.  I know there are additional codes but I believe they bundle. This is what I am thinking...

Surg 1  43840.52
Surg 2  49002.78
Surg 3  49002.78
Surg 4  48146.78
Surg 5  48140.58

all assistants 80

SURGERY 1 day 1

Postoperative Diagnosis 
GSW abdomen, gastrotomy x2, intra-abdominal hemorrhage 
Operation 
Damage control laparotomy with exploration of the abdomen, gastrorrhaphy x2, ligation of bleeding gastric vessel, abdominal packing, and temporary abdominal closure 

SURGERY 2 day 1

 GSW abdomen s/p damage control laparotomy, suspected intra-abdominal bleeding, acidosis, coagulopathy, hypothermia
Postoperative Diagnosis 
GSW abdomen s/p damage control laparotomy, intra-abdominal bleeding, acidosis, coagulopathy, hypothermia
Operation 
 Re-exploration of abdomen with abdominal packing and temporary abdominal closure

SURGERY 3 day 1

PREOPERATIVE DIAGNOSIS:
Gunshot wound to the back, multiple operations.

POSTOPERATIVE DIAGNOSIS:
Avulsion of splenic vein, grade 3 pancreatic injury.

PROCEDURE:
1. Exploratory laparotomy, re-open laparotomy secondary to hypotension and
    possibility of hemorrhagic shock.
2. Clipping of the splenic vein.
3. Packing of gunshot wound with a quick clot.
4. Temporary abdominal closure secondary to damage control surgery.

SURGERY 4 day 1

Indication for Surgery 
retroperitoneal hemorrhage persistent
Postoperative Diagnosis 
same 

Operation
reopen laparotomy
distal pancreatectomy 
control retroperitoneal hemorrhage

SURGERY 5 day 3

PREOPERATIVE DIAGNOSES:
1. Gunshot wound to the abdomen, zone 1.
2. Intra-abdominal catastrophe, multiple operations for control of
    hemorrhage.

POSTOPERATIVE DIAGNOSES:
1. Gunshot wound to the abdomen, zone 1.
2. Intra-abdominal catastrophe, multiple operations for control of
    hemorrhage.

PROCEDURE:
1. Reopen exploratory laparotomy.
2. Exploration of retroperitoneal space, zone #1.
3. Splenectomy.
4. Distal pancreatectomy.


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## TWinsor (Mar 5, 2015)

I think your codes are good but I would use 58 modifier not 78.

HTH


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## ksrkelly7 (Mar 5, 2015)

Thanks Terri,

I was thinking of that also, but each of the 3 additional surgeries on the same day were unplanned return to the OR due to hemorrhage.  I did use 58 on the final day.  What do you think?

Kelly


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