Medical Coding

Category - 30,000 Series

A 48-year-old patient was brought to the Emergency Department following a horseback riding injury. The patient was riding in the woods when the horse spooked at the sight of a snake and bucked the patient, who was subsequently kicked by the horse in the abdomen. The patient was suffering severe internal pain, and upon presentation to the ED, the abdomen was stiff and distended. Suspecting an internal splenic injury, the physician ordered emergency surgery. During the surgery, the physician performed a partial lateral splenectomy with a splenorrhaphy on the anterior face of the spleen. Upon gross inspection, the remaining organs were all intact. The physician then sutured the abdominal cavity and admitted the patient to the ICU for observation. What is the correct procedure code for this service?
  1. 38115
  2. 38101, 38115
  3. 38101
  4. 38120
Explanation
Answer: A - The correct procedure code for the service is 38115 (Repair of Ruptured Spleen (Splenorrhaphy) with or without Partial Splenectomy). It is not necessary to code for 38101 for the partial splenectomy, as the code 38115 includes partial splenectomy as well as the splenorrhaphy. Code 38120 is for a laparoscopic surgical procedure, which is inappropriate.
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