# repair of artery from traumatic laceration



## rachell1976 (Jun 29, 2010)

Trying to determine best code to use for the control of hemorrhage from lacerated artery. MD just sutured the artery, and irrigated the wound along w/ some cautery to control bleeding. Then bandaged the pt up and sent her off to another facilty (we are rural hospital)
Pt was standing on a broken toilet and fell through, lacerating her leg from groin area to below the patella. There was exposed femur and patella & arterial bleeding.

Would I bill 37618 w/ a modifier 52 to show no closure of wound was done?
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PROCEDURE:  She received morphine, Versed, and propofol with appropriate
monitoring of heart rate, blood pressure, and O2 saturations.  The left
lower extremity was prepped with ChloraPrep and draped appropriately.  I
removed direct pressure and identified the arterial bleeder which was at
the medial aspect of the patella.  This was stitched times 2 with 3-0
Vicryl suture.  This seemed to control the bleeding.
Copious irrigation with a suction irrigator and a 60 mL syringe was used
to irrigate the flaps that the wound created over the anterior knee, in
addition to the wound itself.  A portable Bovie cautery was used to
control several venous oozers along the skin edge and muscle.  The wound
was then packed with wet-to-dry gauze and a pressure dressing was placed
over top with fluffs and Kerlix.  The patient tolerated the procedure
well and pulses were again checked and found to be intact.  Neurologic
status again is unable to be assessed at this time.
Patient received a total of 650 mL of normal saline.  As stated, she
appeared to have lost of a copious amount of blood prior to her
presentation.  She also received 450 mg of Ancef empirically.
X-rays of the hip long bone and knee were negative for fracture and
foreign body.
This case was discussed with Dr.  at _____ and plans for transfer
for evaluation by a pediatric surgeon and possible pediatric plastic
surgeon for complex closure and orthopedic and neurologic evaluation
given the extensive nature of the wound with exposed bone, frayed muscle
and extensive tissue loss.
The parents were informed of this decision and agree.  Once she is
stabilized from conscious sedation, she will be transferred via ground
transport given that the bleeding is controlled and the patient is
stabilized.


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