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#1
09-20-2010, 12:42 PM
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clip of cystic artery??
this procedure was done after a lap chole-not sure what codes to use
POSTOPERATIVE DIAGNOSIS: Cystic artery branch bleed. TITLE OF OPERATION: Diagnostic laparoscopy, clip of cystic artery bleeder, evacuation of clot. ANESTHESIA: General endotracheal anesthesia. COMPLICATIONS: None. CONDITION: Stable to Recovery. ESTIMATED BLOOD LOSS: 1000 mL. WOUND CLASSIFICATION: I. NARRATIVE: This is an unfortunate 75-year-old male with history of Kaposi's sarcoma, on chemotherapy, and common bile duct stone. He was brought into the operating room and placed in the supine position on the operating table. The abdomen was prepped and draped in the usual fashion. The epigastric incision and the two 5 mm lateral ports were opened. The port was placed in the epigastric position and the abdomen was insufflated. The camera was inserted. There was a large amount of clot in the right upper quadrant. So, one of the 5 mm ports was switched to a 10 mm port, and an additional 5 mm port was placed to the right of the midline in the abdomen. All the clot was aspirated up above the liver, in the gallbladder fossa. Once all the clot was evacuated from the gallbladder fossa, there was an adherent clot, and it seemed to be the source of the bleeding. Once the clot was completely removed, in an area of three existing clips, there was an arterial bleeder. This was clipped successfully. The area was generously irrigated and suctioned free. The entire abdomen was explored. There was no other misadventure noted. The clot throughout the abdomen was suctioned out. A 10 mm Jackson-Pratt drain was placed in the gallbladder fossa and brought through one of the right lateral ports. All the ports were taken out under direct vision. The 10 mm port fascia was closed with an #0 Vicryl stitch. All skin incisions were closed with staples. The patient tolerated the procedure well, was extubated and brought to the recovery room in satisfactory condition. 
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#2
09-21-2010, 08:33 AM
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Since there is no code for a laparoscopic re-opening (control of hemorrhage) I would either code:
49002-52-78 I would type a note on the claim stating: Reduced b/c was performed laparoscopic not open or 49329-78 (unlisted laparoscopy) I would type a note on this claim that this was a return to OR to control a hemorrhage. Either way states the same thing, it just depends on the insurance carrier or your own preference in billing unlisted codes.
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Melissa Jewett, CPC
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