Orthopedic Coding Alert

Question: During surgery, our orthopedist dictated that she performed "control of bleeding." How should we code for that procedure? Arkansas Subscriber Answer: When the surgeon performs a major procedure, such as spinal fusion (for example, 22554, Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; cervical below C2), the surgery includes bleeding control as a component of the surgery.

If the orthopedic surgeon expends a significant effort to control bleeding during a major procedure, you may append modifier -22 (Unusual procedural services) to the surgical code to try to gain additional reimbursement for the procedure.

You should submit an operative report and cover letter that explicitly describes the unusual nature of the surgery and request additional compensation. If bleeding control was the major procedure the surgeon performed, identify the site and method that the physician used and then code accordingly. For instance, you might report 35201-35286 (related to repair of blood vessel other than for fistula, with or without patch angioplasty) or 37565-37700 (related to ligation and other procedures).