Wiki Laparoscopy with evacuation of blood

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Need help coding the following OP report:

Pre-Op Dx: Postoperative bleed
Post-Op Dx: Postoperative bleed

Procedure: Laparoscopy with evacuation of blood

A Hasson catheter was introduced and the abdominal cavity was insufflated with carbon dioxide gas. A second 5mm triocar was placed in the previous LLQ trocar site, and a third 5mm trocar was ultimately placed in the midline. The abdominal cavity had a significant amount of blood that appeared old as well as a clot present. this was aspirated but all that appeared old. There was no active bright red bleeding. The spleen,liver, pelvis, and fallopian tubes was insepected and found unremarkable. the most likely source of bleeding was the omentum that had been previously taken down from the abdominal wall. There was clot present adherent to omentum. This was cleared with no active bleeding present. There was no evidence of any active bleeding or oozing within theabdomen. A drain was placed abutting the omentum and the most likely site of the bleed.

Any help would be greatly appreciated.
 
I know this post is ancient, but if anyone else is searching and comes across this, I'll put my 2 cents in. I would also recommend 49322. Basically if you are doing the laparoscopic evacuation of hemoperitoneum at the time of another procedure, it would be included (or possibly warrant modifier -22). If no other procedure, then 49322.
 
csperoni said:
I know this post is ancient, but if anyone else is searching and comes across this, I'll put my 2 cents in. I would also recommend 49322. Basically if you are doing the laparoscopic evacuation of hemoperitoneum at the time of another procedure, it would be included (or possibly warrant modifier -22). If no other procedure, then 49322.
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Would you recommend this code for laparoscopic evacuation of pelvic hematoma? Dilatation, suction curettage done 30 days prior to this procedure. Large clot in the posterior cul de sac. Post op diagnosis was pelvic mass. The largest portion of the pelvic clot was removed with suction.
 
Yes, my advice was/is to use 49322 for laparoscopy with evacuation of hemoperitoneum. If any other procedure done at the time, consider -22 on the primary procedure instead, if documentation supports.
I would also suggest using a more specific diagnosis than "pelvic mass" in your case, as it is known before the procedure even concludes that it is not simply a mass, but a post operative hematoma.
 
csperoni said:
Yes, my advice was/is to use 49322 for laparoscopy with evacuation of hemoperitoneum. If any other procedure done at the time, consider -22 on the primary procedure instead, if documentation supports.
I would also suggest using a more specific diagnosis than "pelvic mass" in your case, as it is known before the procedure even concludes that it is not simply a mass, but a post operative hematoma.
Click to expand...
Thankyou!!!
 
csperoni said:
Yes, my advice was/is to use 49322 for laparoscopy with evacuation of hemoperitoneum. If any other procedure done at the time, consider -22 on the primary procedure instead, if documentation supports.
I would also suggest using a more specific diagnosis than "pelvic mass" in your case, as it is known before the procedure even concludes that it is not simply a mass, but a post operative hematoma.
Click to expand...
I am looking at a return to the OR 1-day postop TLH. Same surgeons for both procedures. DX: Postop Hemorrhage. They performed a Laparoscopy w/aspiration (49322) and over-sewing of vaginal cuff using EndoStitch device. I have the 49322 BUT I am wondering if the surgical repair is separately billable? Any thoughts?
 
breyes said:
I am looking at a return to the OR 1-day postop TLH. Same surgeons for both procedures. DX: Postop Hemorrhage. They performed a Laparoscopy w/aspiration (49322) and over-sewing of vaginal cuff using EndoStitch device. I have the 49322 BUT I am wondering if the surgical repair is separately billable? Any thoughts?
Click to expand...
A complication that requires a return to the OR is billable with the appropriate -78 modifier.
If the reason the second surgery was required was due to surgeon error in the first procedure, then I would not consider it billable. Something like - left an instrument in the patient or forgot to tie knots during suturing.
Usually a situation like a postop hemorrhage after TLH is a complication, not necessarily an error.
 
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