injury during surgery

SallieF

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my surgeon wants to charge 44120 which was caused by 10mm trocar during a 47562.
my first question is, is this billable since he caused the intestinal perforation with the trocar and secondly if it is billable which would I code first? the 44120 has higher RVU's than the 47562.
In 5 years this is only the 2nd time this has happened and i am at a loss.
Thank you for your input.
 

jewlz0879

True Blue
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823
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Richardson, TX
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It's my understanding that if the physician creates the problem or has a mishap during surgery he/she should repair it but should not charge for it. I do not have anything in writing, unfortunately.

I'm like you, I don't see if often, I've seen it once but it was done during a AAA and the artery was patched.
 
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Nashville
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From the NCCI policy manual chapter 6:

If an iatrogenic laceration/perforation of the small or
large intestine occurs during the course of another procedure,
repair of the laceration/perforation is not separately
reportable. Treatment of an iatrogenic complication of surgery
such as an intestinal laceration/perforation is not a separately
reportable service. For example CPT codes describing suture of
the small intestine (CPT codes 44602, 44603) or suture of large
intestine (CPT codes 44604, 44605) should not be reported for
repair of an intestinal laceration/perforation during an
enterectomy, colectomy, gastrectromy, pancreatectomy,
hysterectomy, or oophorectomy procedure.
 

wcarmignani

Contributor
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Im bumping this up because I have a case where the rectum was injured during insufflation after performing an anastomosis where the rectum was injured requiring the physician to perform a flex sig, suture repair the rectal injury and then do a diverting loop ileostomy. The only documentation I can even find regarding how to handle/code or not code iatrogenic complications is the above referenced info from NCCI. Just wondering if I should use the NCCI edit info and not give him any of the 3 mentioned procedures as he was essentially fixing his mistake.
 

rkindlund

Networker
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Bellingham, WA
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another surgeon

Follow-up question - if my general surgeon was called in by another surgeon during a hysterectomy to repair the other surgeon's intraoperative injury, is there no code I can bill for my surgeon's work?
 
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