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Official Description

Drainage of subdiaphragmatic or subphrenic abscess, open

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

A subdiaphragmatic abscess refers to a localized collection of pus that forms in the abdominal cavity beneath the diaphragm, while a subphrenic abscess is situated above the diaphragm in the anatomical space that separates the thoracic cavity from the abdominal cavity. These abscesses can arise due to various underlying conditions, such as infections, perforations, or post-surgical complications. The procedure for drainage involves accessing the abscess through various approaches, including transpleural, extrapleural, retroperitoneal (extraperitoneal), or transperitoneal methods. During the procedure, the surgeon thoroughly explores the entire subdiaphragmatic or subphrenic cavity to locate the abscess. Once identified, any loculations within the abscess are separated, and all debris, which may consist of pus, blood, and necrotic tissue, is meticulously evacuated. To ensure complete removal of infectious material, the abscess site is irrigated vigorously with sterile saline or an antibiotic solution. Finally, a drain is placed within the abscess cavity to facilitate ongoing drainage, and the incision is closed around the drain to promote healing while allowing for continued monitoring and management of the abscess site.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The drainage of subdiaphragmatic or subphrenic abscesses is indicated in the following situations:

  • Presence of Abscess A confirmed diagnosis of a subdiaphragmatic or subphrenic abscess, typically identified through imaging studies or clinical evaluation.
  • Symptoms of Infection Patients exhibiting signs of infection, such as fever, abdominal pain, or signs of sepsis, warranting intervention to prevent further complications.
  • Failure of Conservative Management Cases where initial conservative treatment, such as antibiotics or percutaneous drainage, has failed to resolve the abscess.

2. Procedure

The procedure for the drainage of a subdiaphragmatic or subphrenic abscess involves several critical steps:

  • Step 1: Accessing the Abscess The surgeon selects an appropriate approach to access the abscess, which may include transpleural, extrapleural, retroperitoneal (extraperitoneal), or transperitoneal methods. The choice of approach depends on the location and extent of the abscess.
  • Step 2: Exploration of the Cavity Once access is achieved, the entire subdiaphragmatic or subphrenic cavity is explored. This thorough exploration is essential to locate the abscess and assess the surrounding structures.
  • Step 3: Separation of Loculations The surgeon identifies and separates any loculations within the abscess. This step is crucial for ensuring that all infected material is adequately addressed.
  • Step 4: Evacuation of Debris All debris, including pus, blood, and necrotic tissue, is evacuated from the abscess cavity. This step is vital for reducing the risk of further infection and promoting healing.
  • Step 5: Irrigation The abscess site is vigorously irrigated with sterile saline or an antibiotic solution. This irrigation helps to cleanse the area and remove any remaining infectious material.
  • Step 6: Placement of Drain A drain is placed within the abscess cavity to facilitate ongoing drainage of any residual fluid or pus. This is an important step to prevent re-accumulation of the abscess.
  • Step 7: Closure of Incision Finally, the incision is closed around the drain, allowing for continued monitoring and management of the abscess site while promoting healing.

3. Post-Procedure

Post-procedure care involves monitoring the patient for signs of infection or complications. The drain placed in the abscess cavity should be regularly assessed for output and patency. Patients may require follow-up imaging to ensure that the abscess has resolved completely. Pain management and supportive care are also essential components of post-procedure recovery. The healthcare team will provide instructions regarding drain care and signs of potential complications that should prompt immediate medical attention.

Short Descr DRAIN OPEN ABDOM ABSCESS
Medium Descr DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN
Long Descr Drainage of subdiaphragmatic or subphrenic abscess, open
Status Code Active Code
Global Days 090 - Major Surgery
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) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
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) P1G - Major procedure - Other
MUE 2
CCS Clinical Classification 99 - Other OR gastrointestinal therapeutic procedures
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).
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.
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.
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.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
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.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
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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2014-01-01 Changed Code description changed.
2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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