General Surgery Coding Alert

Question: Our surgeon returns a patient to the OR four days following an open partial colectomy due to increasing abdominal pain, bloating, and suppurative inflammation of the wound site. The surgeon opens the surgical site and performs lavage to cleanse and view organs. Should we report this as 49084?

Iowa Subscriber

Answer: No, code 49084 (Peritoneal lavage, including imaging guidance, when performed) is not the appropriate code to report the surgery you describe. Although the note states that the surgeon performs lavage, that’s really just a small part of the work. In fact, 49084 typically involves just a small incision, inserting a catheter, and administering saline to wash the peritoneal cavity.

A better code choice for this case is 49002 (Reopening of recent laparotomy ) with modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period). You’ve described a procedure involving an abdominal incision, lavage, and the surgeon’s examination of internal organs. This is a far more extensive procedure than peritoneal lavage. 

Cost: Choosing the wrong code for this case could have a big impact on your bottom line. Code 49002 pays $1098.57, while 49084 pays just $114.04 (Medicare facility national amount, conversion factor 36.0896). Note that modifier 78 typically results in a payment reduction, depending on the payer.