Ob-Gyn Coding Alert

Question: My ob-gyn performed an operative lap with extensive adhesiolysis and incision and drainage (I&D) of a right ovarian endometrioma. Two days later, the patient reports to the emergency department with bleeding into the peritoneum. The physician returns the patient to surgery and performs evacuation and electrocauterization of the ovary and tube. How should I report this?


Pennsylvania Subscriber

Answer: When you say -lap,- you need to specify whether the ob-gyn performed the original procedure laparoscopically or via laparotomy, because differentiating the two makes a big difference in how you code this.
 
If the original surgery was an open procedure, you should use 49002-78 (Reopening of recent laparotomy; return to the operating room for a related procedure during the postoperative period) for the later procedure.  If the ob-gyn performed the original procedure laparoscopically and now the second procedure is open, you should use 35840-78 (Exploration for postoperative hemorrhage, thrombosis or infection; abdomen) instead. Essentially what happened is the ob-gyn found the bleeders and stopped the bleeding.