# 38100 vs 38102 splenectomy - which of these codes



## Jarts (Mar 19, 2009)

I was wondering if anyone had input on which of these codes would be more appropriate in this case. Must I use 38102 or can 38100 be billed out with mod 59 secondary to 44120 in this case?

PREOP DX: Ruptured Spleen
POSTOP DX:
1. Splenic capsule rupture
2. Small bowel mass

PROCEDURES PERFORMED:
1. Splenectomy
2. Small bowel resection.

FINDINGS AT SURGERY: Significant intraabdominal blood, as well as a ruptured spleen and small bowel tumor (pathology showed malignant).

PROCEDURE IN DETAIL: The patient was brought to the operating room after proper identification, confirmation of PARQ. After stabilization by the anesthesiologist, patient was then prepped an draped in normal sterile fashion. Midline incision was made, carried into the abdominal cavity. Upon entry into the abdominal cavity, left upper quadrant was packed iwth lap pads. At that point, the abdomen was then irrigated with copious amounts of normal saline and suctioned clear to clearly identify the spleen which had ruptured. It was clear that the spleen would not be salvageable since it was split down the middle, and the capsule was completely torn off. We then isolated the splenic hilum with 2 clamps. The end organ was removed, and then the splenic pedicle was then suture ligated with interrupted 0 silk suture. The abdomen was then irrigated with copious amounts of normal saline and suctioned clear. The left upper quadrant and the splenic region was inspected for hemostasis, which was well controlled. The abdomen was then explored. Due to his previous known abdominal pain, the small bowel was ran from the ligament of Treitz to the terminal ileum. We clearly identified a small bowel lesion which appeared to be a mass. It was likely the cause of his abdominal pain. Thus, a segmental resection was done. This was done by taking a wedge resection out of the mesentery with clear margins on either side of the lesion. The mesentery was then divided between Pean clamps. The proximal, distal bowel was divided with a GIA stapler, and then the specimen was removed from the table. The bowel was then reconnected by performing a side-to-side stapled end-to-end anastomosis with a GIA-75 stapler. The anastomosis was reinforced with interrupted 3-0 silkds as was the running 3-0 Vicryl. The abdomen was then irrigated with copious amounts of normal saline. The anastomosis was inspected for any signs of any vascular compromise which there was none. The abdomen was then further inspected for hemostasis, which was well controlled and the decision was made to close.


----------



## bsurovick (Mar 19, 2009)

hey there!  i bill general surgery as well, and i spoke with another gal on my team and we say go with the 38100 and the 44120.  you shouldn't (shouldn't being the operative term!!) have to modify b/c 38100 states to list as a seperate procedure.

Good Luck!

Bridget


----------



## Jarts (Mar 19, 2009)

Bridget, 
THANKS for your input!!

Julie


----------



## FTessaBartels (Mar 20, 2009)

*38102*

I'm not an expert in this, but ...

38102 is an add-on code that specifically is intended to be used when there is a need for a total excision of the spleen, *in conjunction with another procedure*. 

The fact that 38100 has (separate procedure) noted does NOT mean that you should bill it separately without any modifiers. If you look at CPT 2009 Professional Edition, pg 47, under Surgery Guidelines you will find a paragraph that explains the meaning of *Separate Procedure*. I quote in part: The codes designated as "separate procedure" should *not *be reported in addition to the code for the total procedure or service of which it is considered an integral component. (emphasis added by FTB)

Hope that helps.

F Tessa Bartels, CPC, CEMC


----------



## Jarts (Mar 20, 2009)

That was my original feeling as well, but because the two procedures were not related at all I felt like possibly the 38100 could be billed separately as my coding companion indicates "when performed alone or with other unrelated procedures they may be reported. If performed with other procedures, list the code and append mod 59.

I felt like because they went in an did the splenectomy and _then_ ran his bowel _due to previous abdominal pain_ and then found the cancer and had to do the resection, that maybe this would qualify for code 38100 rather than 38102.

What do you think?
Also, this is for medicare.
julie


----------

