General Surgery Coding Alert

Question: When, if ever, may I report control of bleeding as a separate service at the same time as a related surgical procedure?

Florida Subscriber

Answer: Control of bleeding is never separately reportable during a surgical service if the bleeding occurs as a result of the surgery itself. Stated differently, if the surgeon causes the bleeding, you must include management of the bleeding in the procedure fee.

For example, if a surgeon must inject epinephrine to control bleeding that starts during a polyp removal by snare technique, the control of bleeding is included in the code for the tumor removal (e.g., 45385, Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor[s], polyp[s], or other lesion[s] by snare technique).

The AMA supports this guideline, for instance by stating in Principles of CPT Coding that the codes for endoscopic control of bleeding by any method "are intended to be used when treatment is required to control bleeding that occurs spontaneously, or as a result of traumatic injury (noniatrogenic), and not as a result of another type of operative intervention."

The same rules apply for open procedures.

In rare circumstances -- such as those involving trauma cases when control of bleeding adds considerably to the time, effort or resources required to complete the surgery -- you may have the option of appending modifier 22 (Increased procedural services) to the appropriate primary procedure code.

Remember, however, that modifier 22 claims usually require considerable additional effort -- and rock-solid documentation on hand -- to gain additional reimbursement. Payers will want proof that the control of bleeding (usually an included service) far exceeded usual and reasonable expectations during a procedure of the same type.