Wiki B-Lynch procedure during CS

[debellis59]

Hi!

I've never even heard of a B Lynch suture until today ... and I'm stumped. If anyone can help, I'd be so appreciative.

I found a thread (short one) that states to bill with a 22 modifier, but not sure the following really qualifies: "There was still poor uterine tone despite the Oxytocin, Methergine, and uterine massage. A B Lynch suture was placed w/ 1-0 PDS. This was pulled down tight over the uterus and produced better tone." That was the entirety of his note on that.

That being said, the following day, he did a laparotomy to remove the suture:

After informed consent was obtained, Patient was taken to the operating suite where she identified herself and the nature of her planned procedure. General anesthesia was induced. A Foley catheter was already in place. She was prepped and draped in a normal sterile fashion. A time out was performed. DVT and antibiotic prophylaxes were confirmed. The Pfannenstiel incision was opened and suture removed and carried down to the fascia, which was opened and sutures removed. The rectus muscles and peritoneum were entered by removing sutures and using blunt dissection. This Alexis retractor was placed.

The uterus was inspected. The left side of the B Lynch suture was firmly in place over the uterus. The right side was displaced laterally to the right, over the cornua and not tight. This suture was cut and removed. No bleeding was noted. The uterus remained firm.

Hemostasis at the uterine incision was again ensured. The peritoneum and rectus muscles were reapproximated w/ a running stitch using 2-0 Monocryl. The fascia was closed with a single running stitch of 0 Vicryl. The subcutaneous tissue was reapproximated with interrupted stitches of 2-0 Monocryl, and the skin with 4-0 Monocryl. The incision was covered with surgical glue. The patient tolerated the procedure well and was taken to recovery in stable condition.

All that being said, I'm honestly without a clue on how to code this. I could find absolutely nothing. And, unfortunately, I don't have access to the Coding Clinic.

Thank you for any help you can provide.

 

[csperoni]

My understanding of B lynch is that it is used when there is a postpartum hemorrhage in an attempt to control bleeding by providing pressure and preserve the uterus. Just like with Bakri balloon or JADA system, there is no CPT for this.
I always instruct clinicians that if they expect additional payment using -22, I expect clear documentation of the additional work/time/complexity. The way this is written it could have been a 2 minute simple procedure. If that is literally the only documentation in an attempt to use -22, I personally would not find that sufficient. If elsewhere in the record, the hemorrhage control is documented further, then MAYBE.
For the following day, I suggest looking at 49002. 49014 or 35840 seem like more work than was performed. Don't forget your modifier to avoid bundling into the surgery from the day prior.