coding a "biloma"

fentona@bronsonhg.org

I have a patient who is s/p trauma admit and discharge. He is readmitted with a biloma. Initially he had a grade IV liver lac w open wound into cavity and a bile leak with stenting done. This admit they are saying "Grade IV liver laceration now with likely infected biloma". They placed "percutaneous 12 F drain with US guidance and moderate sedation into the perihepatic space". I spoke with our lead coder this morning and we are struggling with a starting point on this one. Looking for any suggestions? All we can come up with is K838 = other specified disease of biliary tract. Any help would be greatly appreciated.
Thanks,
Amy
Amy Fenton, R.N.
Clinical Documentation Specialist
Bronson Hospital
Quality and Safety
601 John Street
Box 59
Kalamazoo, MI 49007
Phone 269-341-8442
Cell 269-720-6650

Unknown

Amy - there's an old Coding Clinic that refers to biloma and may apply to your case.

Postoperative biloma
Coding Clinic, Second Quarter 1999 Page: 14
Effective with discharges: June 1, 1999
Question:

This patient, who is one week status post laparoscopic cholecystectomy that was converted to an open cholecystectomy, was admitted for severe generalized abdominal pain associated with intractable nausea and vomiting. The CT scan of the abdomen reveals a biloma in the right subhepatic space. A catheter was placed with ultrasound and fluoroscopic guidance for drainage. How is postoperative biloma coded and what procedure codes should be assigned?

Answer:

Assign code 997.4, Digestive system complications, as the principal diagnosis. Assign code 576.8, Other specified disorders of biliary tract, as an additional diagnosis. Assign code 54.91, Percutaneous abdominal drainage, for the drainage performed. Code 88.76, Diagnostic ultrasound of abdomen and retroperitoneum, may be assigned as an additional code for the ultrasound guidance.

Biloma, loculated bile leaks or an extraductal collection of bile within a confined capsular space, is a complication associated with abdominal trauma or abdominal surgery. The condition results from either an accessory duct entering the gallbladder bed directly or from the cystic duct stump. The presenting biliary symptoms include nausea and vomiting, abdominal pain and tenderness, and jaundice. If persistent leakage from the biliary system is present, endoscopic or percutaneous stenting of the bile duct or operative control of the leakage may be necessary.

Your case was open abdominal trauma with a liver laceration and contamination of the abdomen. Now, the collection of bile in the recesses of the abdominal cavity could be from the many tiny bile tributaries that were lacerated and not every one of them could be anticipated and individually ligated, so the possibility of bile collection after surgical repair of the liver could be anticipated but, it is assumed that the abdomen could have been drained sufficiently to avoid this occurrence. The fact that it was infected is an additional complication. The patient should have had antibiotics pre-operatively and for days after the first surgery, anticipating an infection could occur. Apparently it did occur. I would consider the GI complication and wound infection both apply to the case. As far as being a PSI, I believe trauma is excluded.

Robert S. Gold, MD
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