Forum - Questions & Answers

Jul 6th, 2016 - DiCamille

Jackson-Pratt and a Frozen Abdomen

Hello Codapedists ~

Reaching out for thoughts in this scenario. We have referenced the Find-A-Code Plain English Description ~ hopefully, our interpretation is in the ballpark!

For this op report, we're looking at 49900 w/a 52 modifier. The 52 modifier because of the limitations the frozen abdomen presents, and the fact that this was performed at bedside (in the patient's hospital room) and not in an actual operating room. Does the "room" matter?

Enterocutaneous fistula

Enterocutaneous fistula

Placement of a Jackson-Pratt drain in the intra-abdominal space.

The patient had a laparotomy with Dr. XXX a couple of days ago for enterocutaneous fistula. She had a frozen abdomen at that time, the best that he could do was put a Malecot catheter into the fistula and pursestringed it. He also placed a wound VAC. However, the amount of drainage has overwhelmed the wound VAC. There was very little drainage coming out of the Malecot catheter, but a lot coming out through the wound VAC; to the point where it was leaking out from around the occlusive dressings, making quite a mess. At the time of this procedure, when I looked at the wound, the running PDS suture had pulled through and was quite loose, although the patient was not at any risk for evisceration because of the frozen abdomen. There was a lot of succuss entericus in the base of the wound and there was a tract from the midline towards the right side where the fistula site was. With this in mind, I elected to try to place a 19-mm Jackson-Pratt drain in that space, hopefully to help suction that fluid out, so that it would not overwhelm the wound VAC.

At the bedside, I injected lidocaine with epinephrine into the abdominal wall at the site where I was planning on placing the drain. With this done, I made an incision and then using a Kelly clamp, I put the Kelly clamp through the entire abdominal wall into the peritoneal cavity and then brought the end of the 19-mm JP out through that site. I positioned it as tightly as I could in the right upper quadrant in the space that I presumed which was communicating with the fluid drainage and cut the drain to appropriate length. This seemed to be in good position. I then sutured the drain to the skin with 2-0 nylon and this seemed to be sucking well. We are going to put the wound VAC back on and will apply continuous wall suction to the Jackson-Pratt drain. The patient tolerated the procedure well.

The codes considered are:
49900-52 97605 K63.2 K66.8

Any thoughts, suggestions, or guidance would be greatly appreciated.

Thanks for taking a peek!

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