General Surgery Coding Alert

Question: During bowel resection, our surgeon dictated that she performed "control of bleeding." How should we code that procedure?

Arizona Subscriber

Answer: When the surgeon performs a major procedure, such as a bowel resection (for example, 44202, Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis), control of bleeding is an included component of the surgery. If the surgeon provided extra work to control bleeding during a major procedure, you may attempt to gain additional reimbursement by appending modifier -22 (Unusual procedural services) to the appropriate CPT code.

For instance, during repair of ruptured abdominal aneurysm, the surgeon must work extensively to prevent excessive blood loss. In this case, report 35081 (Direct repair of aneurysm, pseudoaneurysm, or excision [partial or total] and graft insertion, with or without patch graft; for aneurysm, pseudoaneurysm, and associated occlusive disease, abdominal aorta) and append modifier -22. Provide an operative report and cover letter explicitly describing the unusual nature of the surgery and request additional compensation.

If the major procedure the surgeon performed was control of bleeding, identify the site and method the surgeon used and code for control of bleeding. Some codes that may be appropriate are the 35201-35286 series (Repair blood vessel other than for fistula, with or without patch angioplasty) or the 37565-37700 series (Ligation and other procedures).