Wiki VATS post op hemorrhage

[TnRushFan]

Good morning folks,

One of my surgeons performed a VATS lobectomy on a patient (32663) but after the surgery prior to going to PACU they noticed blood and fluid rapidly accumulating in the chest drains.
They returned to operating bed and performed repeat VATS to find several vessels either actively bleeding or 'oozing' - interventions were done. I have been searching but cannot find a code that accurately covers the repeat VATS exploration and control of hemorrhage (clips, sutures and direct pressure in of different vessels). 32601 really doesn't describe the level of work performed and per NCCI edits I cannot append anyway. 32654 accurately describes the work but it is for traumatic injury only (Optum excerpt: 32654 It is intended to be used only when bleeding occurs spontaneously or as the result of trauma, not when it results from another surgical intervention).

I am stumped and any input is greatly appreciated.
Thanks in advance.

 

[SharonCollachi]

Do you know that the bleeding did not occur spontaneously and that it WAS in fact from the prior procedure??

Also, modifier 78 for unplanned return to OR.

 

[TnRushFan]

Thank you

They never left OR, they noticed the problem when transferring to gurney to take to PACU...the bleeding was definitely from initial procedure. They did have to re-intubate. Please see below the operative documentation excerpt.

...port sites were inspected for hemostasis
...As the patient was being rolled supine for extubation, 200 mL of immediate sanguinous output from the posterior chest tube was observed, with additional bloody fluid collecting rapidly in the tubing. Given concern for hemorrhage, the patient was immediately moved back to the operating table, general anesthesia was induced, and the patient was reintubated with a double-lumen endotracheal tube.
...small lateral thoracotomy was reopened...thorascope inserted
...a total of 500 mL of blood had been collected from the atrium. An additional 200 mL of hematoma was found within the left hemithorax, though upon evacuation of this hematoma, no significant source of hemorrhage was found.
...Small hemorrhage from the anterior- and posterior- most port sites was controlled
...lung parenchyma along the anterior major fissure staple line was oozing slightly and cauterized
...oozing from the surface of parietal pleura near the pulmonary artery was also found, and pressure was held and Surgicel applied
...any remaining hematoma was washed out
...drain and chest tube were repositioned
...chest was then closed in the usual manner

I appreciate all thoughts...

 

[ellis3350]

Look at 35820,78.