deborahcook4040
Networker
OK, A total hip arthroplasty is being done on a 90 yr old woman (??). During this op, she starts bleeding out. There are no vascular sugeons available (this is a rural hospital and there are unfortunates gaps in the specialist call schedules), so my Doc, who is a General Surgeon, is called in to help. She sutures an artery, which she specifies is not the main femoral artery, but an "offshoot" of the main femoral. The wound is completely dry at this point, so she leaves and the hip replacement continues. That was paragraph 1.
In paragraph 2, she's called back in because there's more bleeding. This time the bleeding points are less specific, and she performs an exploration of the groin area and starts putting in clamps and sutures. Sometime during this portion a vascular surgeon arrives and pitches in as well. She does not specify what points are sutured and/or clamped, and the Vascular surgeon didn't dictate anything at all. Per the orthopedic surgeon's dictation he must have been standing in a corner with his fingers in his ears because he didn't see or hear anything while the other surgeons were in the room. His dicatation barely mentions them.
Obviously my Doc needs to dictate in more detail, but I'm not sure what to tell her. I don't even know what I need to know! Part of the problem is that all the vascular codes specify extremity or abdomen, and she refers to the groin area through the whole op report. It's a hip replacement, so I went with extremity codes.
Here are some codes that I've managed to find that meet SOME of the criteria I have.
Paragraph 1:
37618 - Ligation, major artery, extremity. (IS it a major artery?)
35226 - Repair blood vessel, direct, lower extremity (not sure ligation constitutes repair)
Paragraph 2:
35860 - Exploration for postoperative hemorrhage, extremity (not post op, tho)
35761 - exploration not followed by surgical repair, with or without lysis of artery, other vessels. (not sure exploration of vessels applies. It was more like exploration LOOKING FOR vessels.)
Any assistance would be helpful; vascular surgery coding is not something I'm particularly familiar with.
Debby
In paragraph 2, she's called back in because there's more bleeding. This time the bleeding points are less specific, and she performs an exploration of the groin area and starts putting in clamps and sutures. Sometime during this portion a vascular surgeon arrives and pitches in as well. She does not specify what points are sutured and/or clamped, and the Vascular surgeon didn't dictate anything at all. Per the orthopedic surgeon's dictation he must have been standing in a corner with his fingers in his ears because he didn't see or hear anything while the other surgeons were in the room. His dicatation barely mentions them.
Obviously my Doc needs to dictate in more detail, but I'm not sure what to tell her. I don't even know what I need to know! Part of the problem is that all the vascular codes specify extremity or abdomen, and she refers to the groin area through the whole op report. It's a hip replacement, so I went with extremity codes.
Here are some codes that I've managed to find that meet SOME of the criteria I have.
Paragraph 1:
37618 - Ligation, major artery, extremity. (IS it a major artery?)
35226 - Repair blood vessel, direct, lower extremity (not sure ligation constitutes repair)
Paragraph 2:
35860 - Exploration for postoperative hemorrhage, extremity (not post op, tho)
35761 - exploration not followed by surgical repair, with or without lysis of artery, other vessels. (not sure exploration of vessels applies. It was more like exploration LOOKING FOR vessels.)
Any assistance would be helpful; vascular surgery coding is not something I'm particularly familiar with.
Debby
