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CPT 49013: Preperitoneal Pelvic Packing for Hemorrhage Control

CPT code 49013 represents an emergency surgical intervention to control hemorrhage from high–energy pelvic trauma by opening the pelvic cavity and packing the preperitoneal space with absorbent pads. The procedure is critical in trauma care because it provides rapid local control of life-threatening pelvic bleeding when nonoperative measures are insufficient, impacting hospital resource use, trauma protocols, and payment decisions nationwide.

Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and context for the code, typical sites of service, and common billing modifiers. The publication outlines expected benchmarks for utilization and payment structures, summarizes relevant policy updates affecting coding and reimbursement, and situates the procedure within trauma and surgical service lines.

The report is designed to help coding professionals, billing teams, and policy analysts understand how CPT code 49013 is used in acute trauma settings, what documentation and service contexts commonly accompany the code, and which national payers have published instructions or payment indicators affecting its adjudication. Data not available in the input for specific ICD-10 pairings, taxonomies, or related codes.

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Billing Code Overview

CPT code 49013 describes a surgical procedure in which the provider opens the pelvic cavity and packs the preperitoneal space with absorbent content pads to control hemorrhage from high–energy pelvic trauma. This service involves direct operative control of pelvic bleeding through preperitoneal packing.

Service type: Emergency operative hemostasis for pelvic hemorrhage
Typical site of service: Inpatient operating room or trauma operating suite for acute, high-energy pelvic trauma

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Find policies, billing codes, payers, states, and providers

CPT 49013: Preperitoneal Pelvic Packing for Hemorrhage Control

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Get alerted when payer policies referencing 49013 are released or updated.

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Billing Code Overview

Service type: Emergency operative hemostasis for pelvic hemorrhage
Typical site of service: Inpatient operating room or trauma operating suite for acute, high-energy pelvic trauma

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A hemodynamically unstable adult patient after a high-energy pelvic fracture from a motor vehicle collision is brought to the emergency department with ongoing pelvic hemorrhage and signs of shock. The trauma surgeon performs an urgent operative intervention in the operating room or trauma bay. After rapid access to the pelvic/preperitoneal space via a midline laparotomy or suprapubic incision, the surgeon opens the pelvic cavity and performs preperitoneal pelvic packing using absorbent laparotomy pads to obtain tamponade of venous and cancellous bone bleeding. Concurrent damage-control measures such as external pelvic stabilization (sheet, binder, or external fixation), massive transfusion protocol activation, and temporary abdominal closure may occur. The patient may then proceed to interventional radiology for pelvic angiography and embolization if arterial bleeding is suspected or persists after packing, or be taken to the intensive care unit for resuscitation and staged reoperation for pack removal and definitive fixation once physiologically stabilized.

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or routine service	Use when the procedure is the primary, unmodified service performed by the reporting surgeon.
`22`	Increased procedural services	Use when work, time, or intraoperative complexity substantially exceeds typical for pelvic packing (document reasons).
`23`	Unusual anesthesia	Use if general anesthesia is medically contraindicated and substantially more sedation/anesthesia resources are required.
`50`	Bilateral procedure	Not typically applicable; include only if bilateral distinct surgical sites are separately documented.
`52`	Reduced services	Use when the procedure was partially reduced, e.g., aborted prior to completion due to instability.
`53`	Discontinued procedure	Use when the operation was started but terminated due to an intraoperative emergency before pelvic packing completed.
`62`	Two surgeons	Use when a second surgeon performs distinct operative service concurrently (co-surgeon) for pelvic hemorrhage control.
`63`	Procedure performed on infants/children	Use when the patient is a neonate/infant; pediatric-specific reporting as applicable.
`78`	Unplanned return to OR by same physician following initial procedure	Use if the patient returns emergently to the OR for re-packing or additional hemorrhage control within the global period.
`79`	(Not in provided list)	Data not available in the input.
`80`	Assistant surgeon present	Use when an assistant surgeon performs surgical assistance during pelvic packing.
`81`	Minimum assistant surgeon	Use when minimal assistance is provided (if applicable per payer rules).
`82`	Assistant surgeon when qualified resident not available	Use when no resident is available and an assistant is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when an advanced practice clinician provides a portion of the service as allowed by payer rules.

Taxonomy Code	Specialty	Notes
208000000X	General Surgery	Trauma surgeons and general surgeons commonly perform pelvic packing during damage-control surgery.
208600000X	Surgical Critical Care	Surgically trained intensivists involved in damage-control resuscitation and staged care.
207Q00000X	Emergency Medicine	Emergency physicians coordinate initial resuscitation and may assist in ED or trauma bay procedures.
2087S0122X	Orthopedic Trauma Surgery	Orthopedic trauma surgeons may be involved for pelvic fixation and combined hemorrhage control.
364S00000X	Interventional Radiology	Interventional radiologists provide subsequent pelvic angiography and embolization as adjunct therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.44XA`	Fracture of pubis, initial encounter for closed fracture	Pelvic ring fractures causing hemorrhage requiring preperitoneal packing.
`S32.45XA`	Fracture of ilium, initial encounter for closed fracture	High-energy pelvic fractures with potential pelvic bleeding.
`S32.49XA`	Fracture of pelvis, multiple or unspecified parts, initial encounter	Complex pelvic fractures associated with significant hemorrhage.
`S32.81XA`	Other fracture of sacrum, initial encounter for closed fracture	Sacral fractures can contribute to pelvic hemorrhage.
`T79.A11A`	Traumatic shock, initial encounter	Physiologic state often present when pelvic packing is performed for hemorrhage control.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49013`	Open pelvic cavity; packing of preperitoneal space with absorbent pads to control hemorrhage from high-energy pelvic trauma	Primary procedure described; damage-control operative hemorrhage control.
`22318`	Stabilization of pelvic ring, open treatment, includes internal fixation when performed	Performed after initial hemorrhage control when definitive pelvic fixation is indicated.
`27020`	Closure of pelvic traumatic wound; complicated, includes packing removal (unlisted pelvic debridement/closure codes vary)	Used for subsequent procedures to remove packs and perform definitive wound closure or debridement.
`36245`	Selective catheter placement, pelvic arterial branch; includes diagnostic angiography	Performed by interventional radiology for localization of arterial bleeding after or concurrent with packing.
`37244`	Transcatheter occlusion or embolization; nonselective pelvic vessel, each additional vessel	Used when pelvic arterial embolization is required as adjunct to packing for arterial hemorrhage control.

CPT 49000: Intra-Abdominal Exploration with Biopsy

CPT-49002-EXPLORATORY-REOPENING-OF-ABDOMINAL-INCISION

CPT 49002: Reopening of Abdominal Incision for Exploration

CPT-49010-RETROPERITONEAL-EXPLORATION-WITH-BIOPSY

CPT 49010: Retroperitoneal Exploration with Biopsy

CPT-49014-PELVIC-CAVITY-REOPENING-AND-REMOVAL-OF-PACKING

CPT 49014: Reopening Pelvic Cavity and Removal of Preperitoneal Packing

CPT-49020-OPEN-INCISION-DRAINAGE-INTRA-ABDOMINAL-ABSCESS

CPT 49020: Open Incision and Drainage of Intra‑abdominal Abscess

CPT-49040-SUBDIAPHRAGMATIC-ABSCESS-INCISION-AND-DRAINAGE

CPT 49040: Incision and Drainage of Subdiaphragmatic Abscess

CPT-49060-RETROPERITONEAL-ABSCESS-DRAINAGE-OPEN

CPT 49060: Incision and Drainage of Retroperitoneal Abscess

CPT-49062-EXTRAPERITONEAL-LYMPHATIC-FLUID-DRAINAGE

CPT 49062: Extraperitoneal Lymphatic Fluid Drainage

CPT-49082-ABDOMINAL-PARACENTESIS-WITHOUT-IMAGING

CPT 49082: Abdominal Paracentesis Without Imaging

CPT-49083-IMAGE-GUIDED-ABDOMINAL-PARACENTESIS

CPT 49083: Image-Guided Abdominal Paracentesis

Showing 1–10 of 11

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`11`	Normal or routine service	Use when the procedure is the primary, unmodified service performed by the reporting surgeon.
`22`	Increased procedural services	Use when work, time, or intraoperative complexity substantially exceeds typical for pelvic packing (document reasons).
`23`	Unusual anesthesia	Use if general anesthesia is medically contraindicated and substantially more sedation/anesthesia resources are required.
`50`	Bilateral procedure	Not typically applicable; include only if bilateral distinct surgical sites are separately documented.
`52`	Reduced services	Use when the procedure was partially reduced, e.g., aborted prior to completion due to instability.
`53`	Discontinued procedure	Use when the operation was started but terminated due to an intraoperative emergency before pelvic packing completed.
`62`	Two surgeons	Use when a second surgeon performs distinct operative service concurrently (co-surgeon) for pelvic hemorrhage control.
`63`	Procedure performed on infants/children	Use when the patient is a neonate/infant; pediatric-specific reporting as applicable.
`78`	Unplanned return to OR by same physician following initial procedure	Use if the patient returns emergently to the OR for re-packing or additional hemorrhage control within the global period.
`79`	(Not in provided list)	Data not available in the input.
`80`	Assistant surgeon present	Use when an assistant surgeon performs surgical assistance during pelvic packing.
`81`	Minimum assistant surgeon	Use when minimal assistance is provided (if applicable per payer rules).
`82`	Assistant surgeon when qualified resident not available	Use when no resident is available and an assistant is required.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services	Use when an advanced practice clinician provides a portion of the service as allowed by payer rules.

Taxonomy Code	Specialty	Notes
208000000X	General Surgery	Trauma surgeons and general surgeons commonly perform pelvic packing during damage-control surgery.
208600000X	Surgical Critical Care	Surgically trained intensivists involved in damage-control resuscitation and staged care.
207Q00000X	Emergency Medicine	Emergency physicians coordinate initial resuscitation and may assist in ED or trauma bay procedures.
2087S0122X	Orthopedic Trauma Surgery	Orthopedic trauma surgeons may be involved for pelvic fixation and combined hemorrhage control.
364S00000X	Interventional Radiology	Interventional radiologists provide subsequent pelvic angiography and embolization as adjunct therapy.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`S32.44XA`	Fracture of pubis, initial encounter for closed fracture	Pelvic ring fractures causing hemorrhage requiring preperitoneal packing.
`S32.45XA`	Fracture of ilium, initial encounter for closed fracture	High-energy pelvic fractures with potential pelvic bleeding.
`S32.49XA`	Fracture of pelvis, multiple or unspecified parts, initial encounter	Complex pelvic fractures associated with significant hemorrhage.
`S32.81XA`	Other fracture of sacrum, initial encounter for closed fracture	Sacral fractures can contribute to pelvic hemorrhage.
`T79.A11A`	Traumatic shock, initial encounter	Physiologic state often present when pelvic packing is performed for hemorrhage control.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`49013`	Open pelvic cavity; packing of preperitoneal space with absorbent pads to control hemorrhage from high-energy pelvic trauma	Primary procedure described; damage-control operative hemorrhage control.
`22318`	Stabilization of pelvic ring, open treatment, includes internal fixation when performed	Performed after initial hemorrhage control when definitive pelvic fixation is indicated.
`27020`	Closure of pelvic traumatic wound; complicated, includes packing removal (unlisted pelvic debridement/closure codes vary)	Used for subsequent procedures to remove packs and perform definitive wound closure or debridement.
`36245`	Selective catheter placement, pelvic arterial branch; includes diagnostic angiography	Performed by interventional radiology for localization of arterial bleeding after or concurrent with packing.
`37244`	Transcatheter occlusion or embolization; nonselective pelvic vessel, each additional vessel	Used when pelvic arterial embolization is required as adjunct to packing for arterial hemorrhage control.

CPT 49000: Intra-Abdominal Exploration with Biopsy

CPT-49002-EXPLORATORY-REOPENING-OF-ABDOMINAL-INCISION

CPT 49002: Reopening of Abdominal Incision for Exploration

CPT-49010-RETROPERITONEAL-EXPLORATION-WITH-BIOPSY

CPT 49010: Retroperitoneal Exploration with Biopsy

CPT-49014-PELVIC-CAVITY-REOPENING-AND-REMOVAL-OF-PACKING

CPT 49014: Reopening Pelvic Cavity and Removal of Preperitoneal Packing

CPT-49020-OPEN-INCISION-DRAINAGE-INTRA-ABDOMINAL-ABSCESS

CPT 49020: Open Incision and Drainage of Intra‑abdominal Abscess

CPT-49040-SUBDIAPHRAGMATIC-ABSCESS-INCISION-AND-DRAINAGE

CPT 49040: Incision and Drainage of Subdiaphragmatic Abscess

CPT-49060-RETROPERITONEAL-ABSCESS-DRAINAGE-OPEN

CPT 49060: Incision and Drainage of Retroperitoneal Abscess

CPT-49062-EXTRAPERITONEAL-LYMPHATIC-FLUID-DRAINAGE

CPT 49062: Extraperitoneal Lymphatic Fluid Drainage

CPT-49082-ABDOMINAL-PARACENTESIS-WITHOUT-IMAGING

CPT 49082: Abdominal Paracentesis Without Imaging

CPT-49083-IMAGE-GUIDED-ABDOMINAL-PARACENTESIS

CPT 49083: Image-Guided Abdominal Paracentesis

Showing 1–10 of 11

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 49013: Preperitoneal Pelvic Packing for Hemorrhage Control

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Billing Code Overview

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CPT 49013: Preperitoneal Pelvic Packing for Hemorrhage Control

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References