How to code tracheal hemorrhage?

jdibble

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Any thoughts on how to code this aside from using an unlisted code?

DIAGNOSIS: Tracheal hemorrhage, recent tracheostomy

OPERATION: Reintubation and removal of tracheostomy, exploration of wound and control of bleeding.

FINDINGS: Recent tracheostomy that had bled serval times and did have some oozing in serveral places, but no definitive bleed. I was called to see the patient because they were suctioning a fair amount of blood from the traceostomy lumen and the lungs. At the time of the surgery this appeared to be partially a pulmonary hemorrhage and not necessary aspiration of blood. It was felt that the safest course of action would be to simply keep the patient intubated until the coagulaopathy was controlled.

PROCEDURE: The patient was taken emergently to the operating room and , after being adequately sedated, hd the tracheostomy ties removed. Dr. ___ was ready to reintubat the patient, which was performed without difficulty, observing the tube pass the tracheostomy site. Once this was in position below the tracheostomy, suction was used to remove some clots and blood from the tracheostomy. Multiple spots were bovied with fairly continuous bleeding that was mostly oozing and no specific vessel. Thrombin Gelfoam was then used. It was felt that even with an extended tracheostomy, becuase fo the patient's low saturations, it was safer to keep her intubared and the tracheostomy site was packed. She was tranferred to the intensive care unit in critical condition with all final spong, insturment and needle counts correct.

Aside from the unlisted code of 31899, I have thought about 38500 and 31500 but not sure if those are appropriate - or if there is another code that would be more appropriate.

Any help would be greatly appreciated!!

Thanks,
 
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