Ask Dr. Z

Should I report 20100, or 37799 for Ligation of Ext Jugular Vein?

"Patient had a 6 cm oblique laceration just lateral to the sternocleidomastoid with obvious muscle belly visible in the wound. We extended this incision 1 cm superiorly and laterally for better exposure. After further inspection of this injury, there was a clear through-and-through injury to the external jugular vein, and as such, was not amenable to repair. We ligated the proximal and distal vessel using 2-0 silk ties. In similar fashion, we ligated the facial main tributary with a 2-0 silk tie. We transected the vessel to gain better exposure to the underlying structures and we palpated for a carotid pulse which was immediately adjacent to where we ligated the external jugular vein, so we decided to explore the carotid sheath and the sheath was opened utilizing blunt dissection and we were able to dissect out the distal common carotid artery. There was no evidence of laceration or contusion to the artery. Carotid sheath was intact and injured, and no violation to trachea or esophagus."