ED Coding and Reimbursement Alert

Although physicians use the term "lavage" to describe washing out of abdominal wounds during an exploratory procedure, you should be careful not to confuse this with lavage as defined by 49080 (Peritoneocentisis, abdominal paracentisis, or peritoneal lavage [diagnostic or therapeutic]; initial).

During peritoneal lavage (49080) the physician introduces a saline solution into the peritoneal cavity through a needle inserted through the abdominal wall (peritoneocentesis), and then drains and collects the fluid. This fluid undergoes analysis to diagnose, for instance, intra-abdominal bleeding secondary to trauma.

"We use diagnostic peritoneal lavage in the trauma room and emergency department all the time when we are trying to evaluate an abdominal or thoracic injury," notes John F. Bishop, PA-C, CPC, MS, CWS, president of Bishop & Associates in Tampa, Fla.

"We insert the peritoneal trocar and needle, frequently in the umbilicus, and flood in the saline looking for a backwash of blood, clots, tissue bits or infection fluid," according to Bishop.

To perform this procedure, the physician makes a small incision over the abdomen and inserts a catheter through which he introduces and withdraws the solution. Like peritoneocentis or abdominal paracentisis, which involves draining fluid from the abdominal cavity, peritoneal lavage is a simple procedure requiring only local anesthetic.

"Code 49080 does not involve opening the abdomen," explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.

"This is a great example of how fixating on a single term [lavage], or failing to read the entire operative report, can lead to mistakes," Bucknam continues.

Frequently, the ED physician documents "lavage" in the ED, and then a surgeon may take the patient to the operating room and perform a more extensive laparotomy.

Exploratory laparotomy is a more extensive procedure than lavage. This may occur following trauma, for instance, or to treat postoperative complications such as infection. In these cases, "the correct coding is 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 49002 (Reopening of recent laparotomy)," Bucknam explains.