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AHA Coding Clinic® for HCPCS - 2023 Issue 2; Ask the Editor

Repair iatrogenic bladder laceration

A patient was taken to the operating room for a vaginal hysterectomy. The uterus, the right fallopian tube and the right ovary were lysed, clamped and excised in the normal fashion. The left fallopian tube and ovary were not removed. The vaginal cuff was elevated and secured with sutures. A cystoscopy was then performed which noted suture material in the bladder and once removed, revealed a 2 cm laceration. An intra-operative emergent urology consult confirmed a 2 cm cystotomy on the posterior bladder wall. Multiple cystoscopies were performed and using 3-0 chromic, the mucosal layer was closed in a running fashion. A second layer using 2-0 vicryl was then used on top of this layer gathering as much healthy and normal tissue as possible. The bladder was repaired until all areas appeared to be watertight.Is the guidance in Chapter 6, Section E.10, of the NCCI Manual, which addresses reporting repairs for iatrogenic laceration/perforations of the intestine only applicable to intestinal iatrogenic injuries or does it apply to other iatrogenic injuries, such as a bladder injury? In this case, the hysterectomy approach was vaginal and the bladder repair was endoscopic. Is a separate incision required in order to report an iatrogenic injury repair? How is the hysterectomy with bladder repair reported? ...

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