Urology Coding Alert

Question: A patient underwent a left hand-assisted radical nephrectomy and then had to go back for a diagnostic hand-assisted laparoscopy, vessel ligation, clot evacuation, and hematoma evacuation later that day. I’m struggling with the code(s). I was learning toward 49322, but when I look again it doesn’t seem correct. What is the correct code?

California Subscriber

Answer: Your option is either code 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)) or 49322 (Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple)). However, you should probably report code 49322 since it is a better representation of the procedure performed.

During the procedure represented by 49322, the provider examines the inside of the abdomen through a laparoscope. He withdraws the fluid from one or more pockets or sacs, such as a hematoma or other filled cavities or cysts and controls the postoperative internal bleeding.

Do not report the control of bleeding separately as it is included in this code. Do append 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) to treat a surgical complication in this case because the return to surgery is to address the hematoma evacuation within the global period of the initial surgery.