# Jackson-Pratt surgical drain complication



## JDM1228

Just wanted to get some thoughts and suggestions on a diagnosis code for this scenerio:

Pt came in for a total knee replacement. A jackson-pratt surgical drain was inserted for post-op drainage. This is routine and done on all of these patients. When it came time for the nurse on the unit to pull the drain it would not come out and was very painful for the patient. The doctor decided to take the patient to the OR and remove the drain under anesthesia. He was able to pull it out without difficulty. This was originally coded as a surgical complication and assigned ICD-9 dx code 998.4 (foreign body accidently left during procedure). I do not agree with this code and wanted to get some ideas of what you would assign. 
Thanks!


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## Truby

I have the same thing, the drain wouldn't come out, so the surgeon had to take the patient to the OR and open the arthrotomy.  I have the procedure, but wondering about the diagnosis.

I was looking at 998.89.

I don't want to use 998.4 either as the drain was not accidentally left in...


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## Mojo

I am overly cautious about assigning complication codes so excuse my paranoia.  

Just a thought to debate:
Unless the documentation states the JP is non-functioning, is this really a complication when we expect swelling to occur at the surgical site coupled with the patient's lower pain threshold or having no analgesia onboard? If the patient's pain prevented further manipulation and the JP functioned as it should would V58.49, Other specified aftercare following surgery (change or removal of drains), be appropriate in conjunction with other aftercare codes?


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## Truby

I agree, but in my case the drain actually had a stitch in it that prevented it from being pulled out post surgery.

They actually went back in and had to remove the suture prior to removing it from the surgical site.  I think that would probably be considered a complication.

Does that change your thought process any?


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## Mojo

Truby said:


> I agree, but in my case the drain actually had a stitch in it that prevented it from being pulled out post surgery.
> 
> They actually went back in and had to remove the suture prior to removing it from the surgical site.  I think that would probably be considered a complication.
> 
> Does that change your thought process any?



Ah, the plot thickens. Yes, your scenario would create a complication in the removal of the JP. Does your provider routinely suture the JP in place internally (I am only familiar with a suture anchoring the drain to the skin) or was this a misadventure warranting the 998.89?


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## Truby

Indeed a misadventure, never happened before...


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## slc112071

Could you please tell me how you billed for the JP drain removal?  I have the exact same situation, but it was a spinal procedure.


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