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49000or 49020 please help

Tammy Posted Tue 08th of November, 2016 10:21:32 AM
After a vaginal hysterectomy there were complications.pt developed abdominal distention Procedure: The peritoneal incision was extended superiorly and inferiorly. Hemoperitoneum was then evacuated. Patient was placed in slight trendelenburg and the O'connor-O'sullivan retractor was placed and the bowel was packed away using moist lap sponges. The vaginal cuff was exposed as well as the remainder of the pelvis. Small amount of oozing noted from peritoneal edge of fallopian tube remnant. Using 2-0 vicryl in a running fashion, the peritoneum was reapproximated. The anterior aspect of the vaginal cuff was noted to have oozing as well and in a figure of eight fashion, an additional suture of 2-0 vicryl was placed. Small pinpoint bleeders along the bladder bed were cauterized. Gel foam with thrombin was then placed between the anterior aspect of the vagina and the bladder. The vesicouterine peritoneum was then attached to the vaginal cuff in a running fashion with 2-0 vicryl. Irrigation performed and excellent hemostasis noted. All instruments were removed from the abdomen at this time. Sponge and needle counts were correct. The peritoneum was closed with 2-0 vicryl in a running fashion. The rectus muscle was reapproximated in a mattress fashion with 2-0 vicryl. The fascia was closed with 0 vicryl in a running fashion. Irrigation was performed. I wanted to bill 49000 but since they did an evacation of the hemopritoneal I was thinking I could bill 49020. Is drainage the same as evacuation? please let me know.
SuperCoder Answered Wed 09th of November, 2016 14:33:30 PM

Hi Tammy,

With the information given above, If Hemoperitoneum was evacuated as return to the operating room for postoperative hemorrhage, then please see code 35840 (Exploration for postoperative hemorrhage, thrombosis or infection; abdomen) with modifier 78. To further assist you kindly send some details of hysterectomy as well. Feel free to ask for any clarification.

Tammy Posted Thu 10th of November, 2016 08:01:26 AM
Thanks for your help. Code 35840 does not mention vaginal cuff and I believe it is for hemorrhage control via the vessels. I am leaning towards 49000 and 58999(unlisted) for suturing the vaginal cuff via abdominal incision since there is no code for that. What do you think would be a comparable code to for this? please let me know. Thanks!
SuperCoder Answered Fri 11th of November, 2016 16:02:21 PM

Yes, It will be more correct to use 58999 (Unlisted procedure, female genital system (nonobstetrical). 

Tammy Posted Mon 14th of November, 2016 11:46:03 AM
What do you think would be a comparable code to for this? please let me know. Thanks!
Tammy Posted Mon 14th of November, 2016 12:11:17 PM
do you think 49082 would be a good comparable to code?
SuperCoder Answered Tue 15th of November, 2016 08:01:00 AM

CPT 49082 is not the appropriate code to bill. It is better to go for  58999 (Unlisted procedure, female genital system (nonobstetrical). When submitting an unlisted-procedure code, your documentation should also include an explanatory cover letter.

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