Wiki Help with Dilation and curettage under ultrasound guidance with placement of Bakri uterine balloon.

[tblmt1966]

My patient had C-Section in afternoon and then in evening she returned to OR for the D/c under ultrasound guidance with placement of Bakri uterine ballon. Would 59899-78 and compare it to 43460 for Baki Balloon. Then for D/C under ultrasound guidance 59160 with 76986.

Diagnosis
Postpartum hemorrhage
Procedures
Dilation and curettage under ultrasound guidance with placement of Bakri uterine balloon
Indications: surgery for postpartum hemorrhage
Procedure Details:
A weighted speculum was placed in the vagina and clots were suctioned to view the cervix. The anterior lip the cervix was grasped with a ring forcep. Clots were evacuated from the vagina and lower uterine segment using suction device. At this time a sharp banjo curette used circumferentially in the uterine cavity to remove blood products. There was suspicion of possibly a retained portion of placenta in the left cornual region, the tissue obtained will be sent for pathology confirmation. Additionally a suction D&C was performed with a 14 French curved curette. Next a Bakri balloon was placed at the fundus under ultrasound guidance and the first attempt of filling was unsuccessful due to a kink. This was removed and replaced again confirmed in the correct position and filling was successful. The Bakley balloon was fillled up to 500 cc of normal saline. At this time bleeding was vastly improved. Patient did receive 1 bag of hespan, 1 L of albumin with another starting, and is additionally on a phenylephrine drip. All instrument and sponge counts were accounted for. Anesthesia felt she was stable for extubation transport to ICU.

While in the OR I called personally Dr from the CCU team and notified him of the patient's information and current status. Additionally a Jehovah's Witness liaison has been notified and will be meeting the patient in the ICU.

After the surgical case I spoke directly with all family members with a Spanish translator present. I discussed the loss of blood after her cesarean, the performed procedure, and the blood loss during the procedure. I have made them fully aware there is always a possibility of additional procedures and surgeries that may need to be performed for lifesaving measures. I have answered all their questions at this time

 

[nielynco]

Actually, the balloon was placed under ultrasound guidance, not the D&C. I would keep is simple and code 59160-22, 76998 (76986 was deleted in 2007). This will still give the payer the same information, but may avoid a first submission denial for the unlisted code.

 

[tblmt1966]

Actually, the balloon was placed under ultrasound guidance, not the D&C. I would keep is simple and code 59160-22, 76998 (76986 was deleted in 2007). This will still give the payer the same information, but may avoid a first submission denial for the unlisted code.

Hopefully I'm understanding this correctly. Don't bill the 59899-78 for balloon and just bill the 59160 with the modifer 22 and the 76998 for the ultrasound. I still have to add the modifier 78 for the return trip to the OR. What modifer would I put first the 22 or the 78

 

[nielynco]

Hopefully I'm understanding this correctly. Don't bill the 59899-78 for balloon and just bill the 59160 with the modifer 22 and the 76998 for the ultrasound. I still have to add the modifier 78 for the return trip to the OR. What modifer would I put first the 22 or the 78

Correct. The modifier -22 would be listed first as it is the one that impacts payment. The rule of thumb in the case of more than one modifier is to code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first.