Intraoperative Consult and Control of Bleed

Hi Listers! I need some assistance as soon as possible. An OBGYN was performing a TAH/BSO: GYN Oncology team was called to the operating room where a total abdominal hysterectomy was being performed for uterine fibroids During identification of the left IP ligament the ovarian vessels were lacerated, the pedicle had retracted, and bleeding was noted. The patient is a 42-year-old female with a 30- week size uterus due to uterine fibroids, who was recommended by the benign GYN Oncology team for total abdominal hysterectomy, possible bilateral salpingo-oophorectomy. The GYN Oncology team was consulted intraoperatively during the procedure to help with control of bleeding from the left IP ligament.
DESCRIPTION OF THE PROCEDURE: Upon entering the operating room, the patient was in the dorsal lithotomy position in Allen stirrups under general endotracheal anesthesia. A midline laparotomy incision had been made and the uterus was elevated out of the pelvis. We assisted with identifying the left ureter and isolating it. We then identified the left ovarian vessels which were isolated, clamped, and suture ligated at approximately 4 cm above the pelvic brim. The rectosigmoid was examined with no evidence of injury. The case was then turned over to the benign GYN Oncology team.

Thank you in advance for any help. If I need to use an unlisted code, please supply a comparison code.



  • edited June 2017

    This was an intraoperative injury, I would not charge extra; just the basic
    charge for the operation.


  • edited June 2017

    I would report it as limited assist using the same code gyn oncology
    reported and apply modifier -81 with a diagnosis of intraoperative bleed.

  • I agree, it’s an intraoperative complication, and it isn’t separately billable (even if there is a second dictated report).

    It sounds like the second team is part of the same practice as the initial team, and they were consulted as gynecologists, not as oncologists. The 2nd surgeon might be able to bill as a limited assistant though.
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