Reimbursement Advisor

Postdelivery laceration repair, blood evacuation

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Q Our physician did a laparotomy with evacuation of hemoperitoneum and a transvaginal repair of a cervicovaginal laceration. Both were performed on the same day as delivery. I was considering code 49020 for the hemoperitoneum, but am not sure about the laceration repair. Can you help?

A If your physician performed the delivery, the laceration repair will likely be included in the global service—unless it was a 3rd-degree or 4th-degree laceration. For such extensive wounds, look at codes 12001-12007, 12041-12047, and 13131-13133 to see which fits the situation described in the operative report.

If the laceration repair was done at the time of delivery, add modifier -51 (multiple procedure) to the repair code; if the patient was brought back to the operating room for the procedure, use modifier -78 (return to operating room for a related procedure during the postoperative period). Alternatively, you might consider adding modifier -22 (unusual services) to the delivery code for the documented significant additional work involved with the repair.

As for the return to the operating room for blood evacuation: You cannot use 49020, as that code is for draining a peritoneal abscess. Code 49002 (reopening of recent laparotomy) would also be incorrect, unless the delivery was by cesarean. For vaginal delivery, I would use either 49000 (exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 35840 (exploration for postoperative hemorrhage, thrombosis or infection; abdomen).

Note that I could find no CPT reference regarding the intended use of code 35840 as opposed to 49000. However, 35840 is located in CPT’s cardiovascular-system section; this may influence a payer as to acceptable linking diagnoses. The short descriptors for these 2 codes differ slightly: Code 35840 says “exploration of abdominal vessels” while 49000 reads “exploration of abdomen.” Code 35840, by the way, has fewer relative value units than 49000.

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