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Preperitoneal pelvic packing (PPP) is a surgical procedure utilized to manage hemorrhage resulting from pelvic trauma, particularly in patients who are hemodynamically unstable. This condition often arises following significant injuries such as pelvic bone fractures or damage to intra-pelvic organs. The procedure involves creating an incision in the abdominal wall to access the pelvic cavity, allowing for the placement of packing materials to control bleeding. The incision can be made using a midline vertical approach, extending from the pubic symphysis to just below the umbilicus, or through a Pfannenstiel incision, which is a horizontal cut typically used in gynecological surgeries. During the operation, the surgeon carefully dissects through various layers of tissue, including the subcutaneous tissue, linea alba, and peritoneum, to reach the pelvic area. Once accessed, the surgeon can identify and address any hematomas or bleeding sources within the preperitoneal, paravesical, or presacral spaces. The procedure is critical in stabilizing patients by controlling venous bleeding and preventing further complications associated with pelvic trauma.
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Preperitoneal pelvic packing (PPP) is indicated for patients experiencing hemorrhage associated with pelvic trauma. The specific conditions and symptoms that warrant this procedure include:
The procedure for preperitoneal pelvic packing involves several critical steps to ensure effective management of hemorrhage:
After the preperitoneal pelvic packing procedure, patients are typically monitored closely for signs of continued bleeding or complications. The expected recovery involves careful observation in a critical care setting, where vital signs and hemodynamic stability are assessed. Additional imaging studies may be performed to evaluate the effectiveness of the packing and to identify any further interventions that may be necessary. The surgical site will also be monitored for signs of infection or other complications related to the incision and packing materials. Follow-up care is essential to ensure proper healing and to address any ongoing issues related to the pelvic trauma.
| Short Descr | PRPERTL PEL PACK HEMRRG TRMA | Medium Descr | PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA | Long Descr | Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2020-01-01 | Added | Code added. |
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