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#1
04-16-2009, 01:56 PM
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Lap converted to open back to lap??
Has anyone ever seen this done before? I am not sure how to code.
...upon entering the abdominal cavity there were a lot of adhesions. Around the umbilical trocar site there was a loop of bowel, appeared to be a small serosal tear. We elected to do a mini laparotomy at that time. The gas was expelled. The trocar was removed. A small vertical midline incision was made above the supraumbilical trocar site and including the trocar site. The subQ tissue and fascia were divided and the abdominal cavity was entered. The adhesions around this area were lysed. The loop of intestine was fully embolized and broadened the surgical field. A small serosal tear was identified and was repaired with multiple silk sutures transversely. The remainder of the adhesions around the site were immobilized including up towards the xyphoid. This took approx 50% of operative time. Once the adhesiolysis was completed the midline fascia was closed with multiple figure-of-eight #1 Pedia sutures leaving a small opening where the camera trocar was reinserted and secured. Pneumoperitoneum was reestablished. The patient was positioned appropriately. Standard trocars were placed under direct vision with a one additional 5mm trocar in the supraumbilical location to bring the camera close to the right upper quadrant. Some additional adhesions were lysed. We then identified the gallbladder that was elevated and subsequently decompressed percutaneously....... at this point he proceeds w his standard lap chole. I know I shouldnt bill the lap chole w the open code for the enterorrhaphy. He listed his procedures as: 1. Lap chole 2. Mini-laparotomy with lysis of adhesions and enterorrhaphy Does anyone have any suggestions?? Thanks!!
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Mary Beth Gord, CPC 
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