Damage Control Laparotomy (Trauma)

• {'Document all physiology that triggered the damage control decision': 'pH, core temperature, INR, lactate, and base deficit. Standard thresholds are pH ≤ 7.2, temperature ≤ 34-35°C, INR ≥ 1.5, lactate ≥ 5 mmol/L. Document values, not just the conclusion.'}
• Count and record the exact number of laparotomy pads placed — this is a patient safety requirement and is mandatory for the re-look (retained foreign body).
• List every injury identified and what was done or explicitly deferred for each. A single line per injury is sufficient.
• Document temporary closure technique and materials (ABThera, Bogota bag, wound VAC type and size).
• {'Record the massive transfusion': 'units of pRBC, FFP, platelets, and cryoprecipitate used intraoperatively and the ratio.'}
• State the plan for re-look explicitly in the operative note, including expected timing (24-48 hours) and responsible service.

• Bill 49000 (exploratory laparotomy, 12.23 wRVU, 90-day global) when no named definitive repair code applies — i.e., exploration, hemorrhage control with packing only, and bowel stapled in discontinuity without resection or suture. When definitive organ repairs are performed, bill the most extensive procedure as the primary code and additional procedures as separate codes (e.g., 47361 liver repair with packing, 38100 splenectomy, 44120 bowel resection, 44602/44603 intestinal suture). CPT 44005 (enterolysis) is a 'separate procedure' code bundled into any concurrent intra-abdominal surgery per NCCI rules and is NOT an appropriate primary code for damage control laparotomy.
• Temporary abdominal closure (TAC) with a wound VAC (ABThera, KCI) or Bogota bag is bundled into the primary procedure and NOT separately reportable at the index DCL. CPT 49900 is 'Suture, secondary, of abdominal wall for evisceration or dehiscence' — a definitive wound closure code, not a TAC code. For post-DCL open-abdomen wound management at subsequent ICU dressing changes, use 97606 (NPWT >50 cm², 0.59 wRVU) when appropriate.
• Abdominal packing for hemorrhage control is included in the primary procedure code. Do not separately bill packing. Exception: preperitoneal pelvic packing for pelvic fracture hemorrhage (CPT 49014, 6.56 wRVU, 0-day global) when performed as a distinct procedure at the same operation. Document pelvic packing explicitly in the operative note if 49014 is to be billed.
• Planned re-look laparotomy (pack removal and definitive repair) uses modifier -58 (staged or planned procedure), NOT modifier -78. Damage control is explicitly planned at the index operation, making the re-look a staged procedure. Modifier -58 resets the global period and reimburses at 100%; modifier -78 does not reset the global and reimburses at the intraoperative rate (~70-80%). Bill the procedures performed at re-look (47362 for liver pack removal, 44120/44130 for bowel anastomosis, 49002 for reopening) with modifier -58 appended.
• Resuscitative endovascular balloon occlusion of the aorta (REBOA) is billed by the performing provider using CPT 37244 with modifier -52 (temporary occlusion for hemorrhage, reduced services since no permanent device is deployed). CPT 37244 is 'Vascular embolization or occlusion, for arterial or venous hemorrhage.' Document REBOA use, zone, and duration in the operative note.

General coding reference. Verify with your institution’s billing department before submitting claims.

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