Wiki Total abdominal hysterectomy after vaginal delivery

[rockylopez]

Hello Coders. I was coding for a vaginal delivery only (59409) which resulted with postpartum hemorrhage and extensive blood loss. The provider attempted medication and also bimanual exam took the patient same day to to OR and under general anesthesia performed a tah. i only found add on cpt code 59525 but this would apply to after a hysterectomy. When tah is performed same day after vaginal deivery should this be billed with 58150?

The patient continued to bleed. Her first dose of TXA was given at
1300, the second dose of TXA was given at 1400 in the operating room. The
bleeding slowed down and the patient was observed, the uterus then relaxed again
and the patient started bleeding. Bimanual examination was done and the uterine
cavity was noted to be clean, but was not clamping down. A Bakri balloon was
then placed in the uterine cavity and inflated with 460 mL of fluid. The
patient was taken out of the dorsal lithotomy position and started bleeding
again. The decision to perform a hysterectomy was made due to the fact
patient's uterine atony was not resolved with all of the above methods, the
uterotonic agents, as well as using the Bakri balloon and the patient had lost
approximately 1400 mL of blood at this time.

any input is appreciated, thank you.

 

[csperoni]

58150 is the correct code for this situation. 59525 is specifically an add on code for hysterectomy following C-section, which was not the case here. 59525 is valued less than 58150 because the add on code accounts for the patient already being abdominally open. Since the Bakri balloon portion does not have a code, you could consider 59899 unlisted for that, or consider that it added additional work to the hysterectomy.

 

[rockylopez]

Yes thank you very much