Anesthesia Coding Alert

Question: A patient returned to surgery to control postoperative bleeding after having a submandibular gland excised that morning. How should I code this?

Illinois Subscriber

Answer: There's no CPT code for control of postoperative bleeding," and your question doesn't indicate how extensive or time-consuming the second procedure was, which makes this a difficult situation to code.
 
One option is to report 42699 (Unlisted procedure, salivary glands or ducts), which correlates to anesthesia code 00100 (Anesthesia for procedures on salivary glands, including biopsy). Append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to this claim since both procedures were performed on the same date. Submit 998.11 (Hemorrhage complicating a procedure) as the diagnosis for the return to surgery. You could include E878.8 (Surgical operation and other surgical procedures as the cause of abnormal reaction of patient ...; other specified surgical operations and procedures) as a secondary diagnosis, but some states (such as California) do not accept E codes.
 
Coders try to avoid using unlisted-procedure codes whenever possible, partly because carrier reimbursement is often inconsistent, and partly because carriers - and coders - prefer more descriptive codes. Consider using 42961 (Control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; complicated, requiring hospitalization) and appending modifier -78 if the patient stayed on as an inpatient after the second procedure.
 
Carriers may also accept 42962 (Control oropharyngeal hemorrhage, primary or secondary [e.g., post-tonsillectomy]; with secondary surgical intervention) with modifier -78 if the patient went home after the second surgery. Consult the carrier before you determine how you should code this scenario.