Wiki Drainage of labial hematoma without incision

[cubbiecatz]

Hello, our patient had to return to the OR due to postoperative bleeding from a Labiaplasty procedure. The following procedure was performed:

Hematoma of left labia majora noted. Sutures removed and large clot evacuated from wound bed. Two areas of active bleeding noted. These were cauterized with the bovie cautery. Hemostasis was noted. The subcutaneous tissues were reapproximated with multiple figure of eight sutures of 3-0 vicryl. The skin was reapproximated with multiple figure of eight sutures of 4-0 vicryl. Small areas of oozing were also noted on the right labia majora. Cauterization was performed followed by reinforcement of skin suture of 4-0 vicryl in the area of concern x 3. Hemostasis noted. Sponge, needle and instrument counts were correct. Patient tolerated procedure well and went to recovery in stable condition.
Can I use 10140 if there wasn't an incision?

Thank you,

 

[nielynco]

Hello, our patient had to return to the OR due to postoperative bleeding from a Labiaplasty procedure. The following procedure was performed:

Hematoma of left labia majora noted. Sutures removed and large clot evacuated from wound bed. Two areas of active bleeding noted. These were cauterized with the bovie cautery. Hemostasis was noted. The subcutaneous tissues were reapproximated with multiple figure of eight sutures of 3-0 vicryl. The skin was reapproximated with multiple figure of eight sutures of 4-0 vicryl. Small areas of oozing were also noted on the right labia majora. Cauterization was performed followed by reinforcement of skin suture of 4-0 vicryl in the area of concern x 3. Hemostasis noted. Sponge, needle and instrument counts were correct. Patient tolerated procedure well and went to recovery in stable condition.
Can I use 10140 if there wasn't an incision?

Thank you,

I would report 10140 for this procedure as it can include suture closure, but I also note that he did a layered, not single closure which is more work. While you can also bill 1204x codes with 10140, they are bundled and would require a modifier. Note that 12041 (for instance) is bundled into 10140 so the modifier -59 would have to go on 12041, not 10140. Not sure, however, if this documentation would be enough to warrant reporting a modifier -22 on 10140, but that might be an option as well.

 

[cubbiecatz]

I would report 10140 for this procedure as it can include suture closure, but I also note that he did a layered, not single closure which is more work. While you can also bill 1204x codes with 10140, they are bundled and would require a modifier. Note that 12041 (for instance) is bundled into 10140 so the modifier -59 would have to go on 12041, not 10140. Not sure, however, if this documentation would be enough to warrant reporting a modifier -22 on 10140, but that might be an option as well.

Thank you so much Melanie!