Coding for Damage-Control Surgery

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The American College of Surgeons (ACS) General Surgery Coding and Reimbursement Committee (GSCRC) frequently receives questions regarding appropriate coding for “damage-control laparotomy” or “damage-control surgery.” Damage-control surgery typically involves a multistage approach and is performed with the intention to first avoid or correct the lethal triad of hypothermia, acidosis, and coagulopathy before definitive management of injuries. The general concept is the expedient control of life-threatening bleeding and contamination, usually terminated as soon as possible in order for the patient to undergo correction of physiologic abnormalities due to hemorrhagic shock or sepsis. Subsequent stages of surgery address definitive management when the patient is stable and able to undergo more prolonged procedures. Initially developed by the military and major trauma centers, the concept of damage-control surgery is now widely accepted and may be applied to the chest, abdomen, or extremities.