Wiki 43840 with 49020-59

[Retrophaze]

We have some debate going on in which the patient had Perforated distal gastric ulcer. 43840 with 49020-59

"signs of fibrinous exudate and likely a perforated ulcer.............. source was the perforated ulcer in distal stomach. About a 3mm perforation was seen. There was not much peritoneal contamination present other than local inflammation and fibrinous exudate"


43840 contains "The perforation is sutured closed and the peritoneal cavity is irrigated and suctioned to remove contamination"




Please help me with this debate

 

[cgaston]

49020 is included in 43840. The documentation does not support that the draining was done for anything outside of the ulcer repair so it would not be appropriate to bill the 49020-59 separately.

 

[Retrophaze]

Colectomy with abscess drainage 44143 and 49020-59

So, they are on a 49020 roll and also want it on all colectomy procedures that mention peritonitis, such as 44143 (Hartman's). I specifically asked someone at a seminar this scenario and was told no:

If the doctor opens a patient and finds an abscess on one portion of intestine (say transverse), drains it, and then performs a Hartman's (not involving the transverse), can we bill a 49020-59 with it?

If the doctor opens a patient and finds pus and fecal matter in the abdomen due to perforation, drains it, and then performs a Hartman's, can we bill 49020-59?

I know my opinion/thoughts on it but don't want to sway anyone with them.