Control of Bleeding: When Is It Separate?
Control of bleeding during surgery is not separately reportable if the bleeding occurs as a result of the surgery itself. Think of this as the, “You break it, you buy it” rule. For example, a surgeon injects epinephrine to control bleeding during a polyp removal (e.g., 45385, Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique). Because the hemorrhage is due to snare polypectomy, control of bleeding is not separately reported. Control of bleeding codes (e.g., 44378, Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) are appropriate when treatment is required to control bleeding that occurs spontaneously, or as a result of traumatic injury. Per the April 2012 CPT Assistant, active bleeding does not need to be documented to use the endoscopic control of bleeding codes. For example, when lesions such as angiodysplasia of the intestine are associated with chronic intermittent bleeding that is not specified as active during the procedure, ablation may be considered control of bleeding. Although control of bleeding is included during the same session as the original procedure, if the provider must perform control of bleeding with a later return to the operating room, you may report the control of bleeding separately using the appropriate code appended with modifier 78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period. For example, a surgeon performs a flexible sigmoidoscopy with control of bleeding to remove rubber bands within the global period of a rubber band ligation (46221 Hemorrhoidectomy, internal, by rubber band ligation(s)). In this case, you may report 45334 Sigmoidoscopy, flexible; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) with modifier 78 to indicate that the surgeon performed the control of bleeding, which was a complication related to the initial rubber band ligation.