Jholden21
New
We are having a debate on which CPT for this procedure and I'd love some more experienced insight!
Procedure: Exploration, washout and packing of preperitoneal/retroperitoneal hematoma
Postop diagnosis: Extraperitoneal hematoma
Small incision was made in the suprapubic region on the left side and carried down to the fascia using electrocautery. Anterior fascia was opened and the rectus muscle was retracted gently laterally. The retrorectus and preperitoneal space was then entered and found to have a large pressurized hematoma containing about 1000 mL of content of old blood, clot and some early liquefication. Hematoma was evacuated. Preperitoneal space was then irrigated with 2 L of saline with vancomycin. The area was then packed with laparotomy pads which were left in place for several minutes and then removed to assess hemostasis. With removal of the lap pads it appeared that there was no ongoing or continuing bleeding from the retroperitoneal preperitoneal space. Hemoblast was placed within the space as well as a sheet of Surgicel. Drain was placed into the space. Fascia was closed. Subcutaneous tissue and skin were reapproximated.
Would 49010 be appropriate based on the pre/retroperitoneal hematoma dx (supposedly a hematoma can span between the two regions) and confirmation that bleeding had stopped in the retroperitoneal space indicating some level of access/visualization of that area? If so, would it cover the hematoma evac/washout? Or is 49010 not applicable due to approach/washout being in preperitoneal area? We can't find anything on coding clinics/CPT Asst/other forums that fit this particular scenario without entering the peritoneum.
Thanks for any help!
Procedure: Exploration, washout and packing of preperitoneal/retroperitoneal hematoma
Postop diagnosis: Extraperitoneal hematoma
Small incision was made in the suprapubic region on the left side and carried down to the fascia using electrocautery. Anterior fascia was opened and the rectus muscle was retracted gently laterally. The retrorectus and preperitoneal space was then entered and found to have a large pressurized hematoma containing about 1000 mL of content of old blood, clot and some early liquefication. Hematoma was evacuated. Preperitoneal space was then irrigated with 2 L of saline with vancomycin. The area was then packed with laparotomy pads which were left in place for several minutes and then removed to assess hemostasis. With removal of the lap pads it appeared that there was no ongoing or continuing bleeding from the retroperitoneal preperitoneal space. Hemoblast was placed within the space as well as a sheet of Surgicel. Drain was placed into the space. Fascia was closed. Subcutaneous tissue and skin were reapproximated.
Would 49010 be appropriate based on the pre/retroperitoneal hematoma dx (supposedly a hematoma can span between the two regions) and confirmation that bleeding had stopped in the retroperitoneal space indicating some level of access/visualization of that area? If so, would it cover the hematoma evac/washout? Or is 49010 not applicable due to approach/washout being in preperitoneal area? We can't find anything on coding clinics/CPT Asst/other forums that fit this particular scenario without entering the peritoneum.
Thanks for any help!