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Posted By Mary Peabody on 03-02-2020, 13:14:27 in Ob-Gyn
Hello Melanie,

Would you report the closure of hysterotomy by a different physician with 49000-78 or 59350-78

The cesarean and cystoscopy was performed by the OB physician. Due to uterine atony and hysterotomy bleeding the GYNONC physician was called in to evaluate the bleeding
Pre-Operative Diagnosis: intraoperative hemorrhage during c-section
 Post-Operative Diagnosis: same
 Procedure: closure of hysterotomy
______ who was having a cesarean section for arrest of descent. Prior to my arrival in the OR, she was noted to have hemorrhage approximately 2L blood loss, obstetrics team called for assistance with hemostasis and possible hysterectomy. She had apparently received 2u pRBCs and her hemacue estimated the hemoglobin to be 9, no coags had been checked at that point. She had received uterotonics and TXA. See the obstetrics team's notes and documentation for further details.
Findings:
1. Inferior aspect of the bladder peritoneum (inferior edge of the bladder edge) had been approximated to the superior aspect of the hysterotomy.
2. 500 mL clot evacuated from the uterus
3. Hysterotomy was identified and closed in 2 layers, hemostasis was achieved
I arrived, placed a self-retaining Alexis retractor and packed the bowel, the uterus was exteriorized and I examined the uterus. There was brisk bleeding from the left aspect of the hysterotomy. It looked to me as if bladder was trapped below this initial attempt at hysterotomy closure. I opened the peritoneum inferior to the round ligament on the left, the anterior leaf of the broad ligament, and was able to identify the uterine artery lateral and I could see the bladder folded below the initial attempt at hysterotomy. I took down this closure and we recognized that this was the bladder peritoneum, the inferior edge of the bladder flap, which had been stitched to the superior aspect of the hysterotomy. I identified the inferior aspect of the hysterotomy, placed Pennington clamps on this muscular edge of the hysterotomy and pulled it up superiorly, The bladder was mobilized inferiorly and was noted to be quite inferior to hysterotomy. I evacuated 500 mL clot from the uterus and then the hysterotomy was closed in two layers with 0 monocryl in the usual fashion, first layer running locked and the second layer imbricating layer, same suture. The hysterotomy was then hemostatic. The bladder was far away inferiorly and was the peritoneum, not the actual bladder which had been previously sutured. I then unscrubbed and left the obstetrics team to close the fascia, sub-cutaneous tissue and skin. The lap count was correct before the fascia was closed.
Comments (1)
Posted By Melanie Witt on 03-04-2020, 13:02:06
59350 is the correct code, but a modifier -78 would not be correct as the same physician who did the delivery is not doing the repair. In fact as he was a different physician no modifier should be required - be sure to create a separate claim for this service by this MD.
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