Forum - Questions & Answers

Feb 13th, 2013 - Shelzee

Repair of Vaginotomy?

Patient was seen after vaginal delivery, during which she had an enormous uterine and vaginal rupture which resulted in hemorrhagic shock. She required emergent hysterectomy and her abdomen was packed with laparotomy sponges. She is now returning to the operating room for removal of intra-abdominal packs, repair of vaginotomy and omental pedicle flap.
According to the Operative Report, "her fascial suture was cut and her abdomen was entered. Her pre-existing laparotomy sponges were removed. Brief exploration of the abdomen revealed no obvious hemorrhage, but there was at least 2 liters of old blood. This was easily evacuated. Attention was turned to the pelvis. There was a small amount of oozing from the right pelvic sidewall. Otherwise, no obvious bleeding was identified. Vaginal edges were identified and oversewn using a locking suture. Twenty milliliters of FloSeal were placed in this area as well as NU-KNIT. Liver, spleen, stomach, colon and bowel (from ligament of Treitz to the ileocecal valve) were all normal. Attention was then turned back to the pelvis. Laparotomy sponge was removed and the pelvis was hemostatic. To ensure proper coagulation postoperatively, I elected to place a pedicle flap in the pelvis. The right side of the omentum was taken off the hepatic flexure of the colon. This provided excellent viable omentum which was brought to the pelvis on top of the left colon."
I don't think I can bill for removal of the laparotomy sponges, but my main question is what to bill for evacuation of the old blood and suturing of vaginal edges? I've considered 57022, but this was done through the abdomen, and no speculum was used (besides - not sure if this constitutes a vaginal hematoma?). The only other code that comes close is 57284 (repair of paravaginal defect). I think this one is more appropriate because it describes open abdominal approach. Any help would be greatly appreciated. This is being done by a colo-rectal surgeon so I am not completely familiar with coding for the female genital system. Thanks!



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