Ob-Gyn Coding Alert

Question: How do I code for a patient who had a total vaginal hysterectomy (TVH), then had to return to the operating room that same day for an exploratory laparotomy, evacuation of hemoperitoneum with ligation of bleeding blood vessel?

California Subscriber

Answer: There is no perfect code to report this service because the physician is not reopening the original incisional site, but rather making an abdominal incision. The closest code for the return to the operating room (OR) is 49000 (exploratory laparotomy). This code includes examining the abdominal cavity for bleeding, ligating any vessels, and evacuating the hemoperitoneum. Use this code with the -78 modifier to indicate a return to the operating room for a related procedure during the postoperative period.