Results 1 to 9 of 9

Evacuation of abd wall hematoma

  1. Question Evacuation of abd wall hematoma
    Medical Coding Books
    I'm needing help with CPT codes please!

    The patient below underwent a lap chole and returned to the ER a couple days later for abdominal wall hematoma. The dr describes the procedure as an evacuation of abdominal wall hematoma.

    Op Note:
    A subcostal incision was made. Using the cautery, we incised the anterior rectus sheath and almost immediately was a large expression of blood clot. We incised the remainder or the rectus muscle with cautery. Clot and old blood was evacuated throughout the entire length of the rectus sheath. Oozing vessels and oozing from the rectus was controlled with cautery. I incised the posterior sheath and the peritoneum to inspect intra-abdominally and there was no bleeding from here.

    The posterior sheath and peritoneum were closed with a running 0Vicryl continuous suture. Hemostasis of the rectus sheath was felt to be excellent. A large Blake drain was placed within the sheath and brought out through a separate lateral insicion, securing it to the skin with a 2-0 silk. The anterior sheath was closed with a running 0 looped PDS continuous suture. The skin was closed with a stapler.

    any help is much appreciated!

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by pamley11 View Post
    I'm needing help with CPT codes please!

    The patient below underwent a lap chole and returned to the ER a couple days later for abdominal wall hematoma. The dr describes the procedure as an evacuation of abdominal wall hematoma.

    Op Note:
    A subcostal incision was made. Using the cautery, we incised the anterior rectus sheath and almost immediately was a large expression of blood clot. We incised the remainder or the rectus muscle with cautery. Clot and old blood was evacuated throughout the entire length of the rectus sheath. Oozing vessels and oozing from the rectus was controlled with cautery. I incised the posterior sheath and the peritoneum to inspect intra-abdominally and there was no bleeding from here.

    The posterior sheath and peritoneum were closed with a running 0Vicryl continuous suture. Hemostasis of the rectus sheath was felt to be excellent. A large Blake drain was placed within the sheath and brought out through a separate lateral insicion, securing it to the skin with a 2-0 silk. The anterior sheath was closed with a running 0 looped PDS continuous suture. The skin was closed with a stapler.

    any help is much appreciated!
    49010-78 looks as close as I can figure.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. Default
    What about 49002-78? Sounds like Dr did a Reopening as described in OpNote "incised the posterior sheath and the peritoneum to inspect intra-abdominally". Hematoma, debridement, and cautery would all be incidental to the more extensive procedure.

    Good luck!

  4. Default
    I looked at 49010 but it is for retroperitoneal exploration and he stayed in the anterior abdominal wall.
    Last edited by pamley11; 01-09-2012 at 04:01 PM.

  5. Default
    49002 - That would have been my choice except he didn't do a laparotomy on the first surgery. Since the chole was laparoscopic, I didn't think this would apply.

  6. Default
    You're right, that didn't register. Why not 49000 than? Dr is still entering the cavity and "exploring" for bleeding. Dr is doing a Laparotomy (however small it is) and 49000 doesn't describe how much exploration needs to be done.

    Good Luck

  7. Default
    I'm thinking you're right.

    Thanks so much for the help!

  8. #8
    Default
    Thanks for this discussion. There's been several of these lately that have caused me some trouble, just like what was discussed.
    Here's another issue; would anyone consider the hematoma to be traumatic since the lap chole preceded it? I've got a hospital coder stating 729.92, but I'm considering using 922.2 with E878.6.

  9. #9
    Default
    I would go with 49000-78 as well. Can't do 49002 and it's not retroperitoneal. Good case.

Similar Threads

  1. Coding Evacuation of abdominal wall hematoma
    By Mklaubauf in forum General Surgery
    Replies: 1
    Last Post: 07-12-2016, 03:41 PM
  2. Coding abd wall excision
    By kz@amrsco.com in forum General Surgery
    Replies: 3
    Last Post: 05-21-2013, 01:52 PM
  3. Hematoma evacuation
    By jperkins in forum Cardiology
    Replies: 1
    Last Post: 03-01-2011, 07:03 AM
  4. Evacuation of hematoma
    By carol52 in forum General Surgery
    Replies: 1
    Last Post: 11-17-2010, 07:41 AM
  5. Evacuation of Hematoma
    By RainyDaze in forum General Surgery
    Replies: 2
    Last Post: 10-01-2008, 11:53 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.