# Intraoperative consult?! HELP!



## SienTC1720 (Nov 5, 2015)

The surgeon I code for was called in for an intraoperative consult, on a patient having a laparoscopic salpingo-oophorectomy:

  The Veress needle was inserted at the level of the umbilicus but was not successful and a 12 mm port Hassan was inserted instead. A 5 mm port was in the suprapubic position. There was noted to be a hematoma in the retroperitoneum inferior to the Veress needle insertion site, and I was called to consult. Upon examination, there was a hematoma which measured about 5 cm in the superior inferior direction and about 3 cm in the medial to lateral direction  slightly to the right of midline, extending from just below the umbilicus where there was a small puncture site into the  retroperitoneum, and the hematoma extended in a cephalad  direction. The hematoma was not tense. It was not expanding. The  hematoma was observed for 15 minutes, no expansion was noted. Gas  was allowed to escape from the abdominal cavity relieving the  pneumoperitoneum. The hematoma was reinspected, no evidence of  expansion was noted, and there was no evidence of bowel injury.  The hematoma appeared to be inferior to the mesentery of small bowel. The iliac was cephalad to the hematoma. The hematoma was from a venous injury and was stable and nonexpanding, therefore  recommended that no exploration of the hematoma will be performed  and that the patient will be observed. 

Can I bill for this consult, and what code should I use?


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## manib84@yahoo.com (Nov 6, 2015)

The consult code also depends on the payer. Both Medicaid and Medicare in AL (where I live do not accept consult codes.)


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