Urology Coding Alert

Question: A 10-month old had a circumcision and went to the recovery room. Nothing in the operative report stated that there was any complication. Later that same day, the baby went back to the OR for control of bleeding. There was no scar or skin revised. I looked at the code definition for "circumcision revision," and that code does not seem to fit. Is an integumentary code (12xxx) appropriate for this?

Tennessee Subscriber Answer: Depending on what the doctor actually performed, consider reporting 10140 (Incision and drainage of hematoma, seroma, or fluid collection) or 35840 (Exploration for postoperative hemorrhage, thrombosis or infection; abdomen). All operations include in their global fee the control of bleeding, and you cannot bill for this separately. However, in this case the patient was returned to the OR after leaving the operative theater for control of bleeding that apparently started after the doctor concluded the procedure. Because of this, the return to the OR for treatment for a complication may be a billable service.

Because the circumcision has a ten-day global, and the complication occurred within that ten-day period, append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to 10140 or 35840. The modifier indicates the patient had to return to the OR for a procedure related to the circumscision.

Link the procedure to ICD-9 code 998.11 (Hemorrhage complicating a procedure) or 998.12 (Hematoma complicating a procedure), as the operative notes indicate.