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Old 09-24-2009, 01:55 PM
Jarts Jarts is offline
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Default Abdominal hypertension surgery

I'm hoping someone can give me some input on codes for the following surgery. I had put this to the general surgery forum with no responses - does anyone here have any input for me?

My first question is on the dx codes. The pre-op dx was Acute alcoholic pancreatitis with liquefaction of the pancreas and abdominal hypertension.

POSTOPERATIVE DX: Abdominal hypertension

My second question is on the CPT coding:

PROCEDURE PERFORMED:
1. Exploratory laparotomy.
2. Feeding jejunostomy.
3. Drainaige of lesser sac and peripancreatic space.
4. Placement of abdominal wall compartment syndrome wound VAC system.
5. Partial Omentectomy.

FINDINGS AT SURGERY: Approximately 3 liters of biLious ascites in the abdomen. The pancreas appeared to be acutely inflamed without any evidence of necrosis. Intraoperative Gram stain showed gram-negative pathogens.

DESCRIPTION OF PROCEDURE: The patient was brought to the opering room after proper identification, confirmation of PARQ and appropriate time out. After adequate general anesthesia a midline incision was made. Upon entry into the peritoneal cavity the small intestine and contents basically ballooned out of the abdomen, and then the patient's clinical status according to the anesthesiologist improved significantly. The abdomen was then suctioned removing approximately 2500 mL of ascites. The small bowel was then removed from the abdominal cavity and the incision was extended. We then entered into the lesser sac by dividing the gastrocolic attachments using clamp and tie technique. We then identified the pancreas which appeared to be black in color but firm without any signs of any liquefaction. An 18-gauge needle was then used to aspirate into the body of the pancreas to see if there was any signs of any abscess or liquefaction and none was identified.

The abdomen was then irrigated with copious amounts of normal saline and decision was made to place a feeding jejunostomy. There were 2 small serosal tears which were removed more to repaired with interrupted 3-0 silks. Then a pursestring in the proximal jejenum was made with 3-0 silk. An enterotomy was made and then a significant amount of suction was done to remove the small bowel contents to help replace the small bowel into the abdomen. Then, a 14-French red rubber catheter was brought through the left upper quadrant stab incision, inserted into the small intestine through the enterotomy, and then the pursestring was brought down around the catheter. Then, a standard Witzel tunnel was made with interrupted 3-0 silks. The abdomen was then positioned, the small bowel was replace din the abdominal cavity, and decision was made to place a wound VAC abdominal compartment syndrome kit. The fenestrated nonadherent plastic with the wound VAC sponge was placed in the abdominal cavity underneath the fascia with slits cut around the drain and a feeding tube with the plastic sheeting going down into each pericolic gutter. The wound VAC was then placed just below the fascial layer and a second wound VAC sponge was placed in the abdominal wall and then the abdominal wall was sealed with 3 sheets of the abdominal wound VAC sheeting. A wound VAC was then hooked up to suction, which created excellent seal and began removing abdominal fluid of approximately 300 mL immediately. The sterile dressings were applied to the drain and feeding tube sites and the operation was terminated.

Do these codes look correct?
49000 - there must be a better code than this for all he did, but I'm not finding it???
44015
What do I use for wound VAC system?? I find 97605/97606 - is this appropriate in OR?

Help?
Julie
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Old 09-25-2009, 12:09 PM
Bella Cullen Bella Cullen is offline
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Quote:
Originally Posted by Jarts View Post
I'm hoping someone can give me some input on codes for the following surgery. I had put this to the general surgery forum with no responses - does anyone here have any input for me?

My first question is on the dx codes. The pre-op dx was Acute alcoholic pancreatitis with liquefaction of the pancreas and abdominal hypertension.

POSTOPERATIVE DX: Abdominal hypertension

My second question is on the CPT coding:

PROCEDURE PERFORMED:
1. Exploratory laparotomy.
2. Feeding jejunostomy.
3. Drainaige of lesser sac and peripancreatic space.
4. Placement of abdominal wall compartment syndrome wound VAC system.
5. Partial Omentectomy.

FINDINGS AT SURGERY: Approximately 3 liters of biLious ascites in the abdomen. The pancreas appeared to be acutely inflamed without any evidence of necrosis. Intraoperative Gram stain showed gram-negative pathogens.

DESCRIPTION OF PROCEDURE: The patient was brought to the opering room after proper identification, confirmation of PARQ and appropriate time out. After adequate general anesthesia a midline incision was made. Upon entry into the peritoneal cavity the small intestine and contents basically ballooned out of the abdomen, and then the patient's clinical status according to the anesthesiologist improved significantly. The abdomen was then suctioned removing approximately 2500 mL of ascites. The small bowel was then removed from the abdominal cavity and the incision was extended. We then entered into the lesser sac by dividing the gastrocolic attachments using clamp and tie technique. We then identified the pancreas which appeared to be black in color but firm without any signs of any liquefaction. An 18-gauge needle was then used to aspirate into the body of the pancreas to see if there was any signs of any abscess or liquefaction and none was identified.

The abdomen was then irrigated with copious amounts of normal saline and decision was made to place a feeding jejunostomy. There were 2 small serosal tears which were removed more to repaired with interrupted 3-0 silks. Then a pursestring in the proximal jejenum was made with 3-0 silk. An enterotomy was made and then a significant amount of suction was done to remove the small bowel contents to help replace the small bowel into the abdomen. Then, a 14-French red rubber catheter was brought through the left upper quadrant stab incision, inserted into the small intestine through the enterotomy, and then the pursestring was brought down around the catheter. Then, a standard Witzel tunnel was made with interrupted 3-0 silks. The abdomen was then positioned, the small bowel was replace din the abdominal cavity, and decision was made to place a wound VAC abdominal compartment syndrome kit. The fenestrated nonadherent plastic with the wound VAC sponge was placed in the abdominal cavity underneath the fascia with slits cut around the drain and a feeding tube with the plastic sheeting going down into each pericolic gutter. The wound VAC was then placed just below the fascial layer and a second wound VAC sponge was placed in the abdominal wall and then the abdominal wall was sealed with 3 sheets of the abdominal wound VAC sheeting. A wound VAC was then hooked up to suction, which created excellent seal and began removing abdominal fluid of approximately 300 mL immediately. The sterile dressings were applied to the drain and feeding tube sites and the operation was terminated.

Do these codes look correct?
49000 - there must be a better code than this for all he did, but I'm not finding it???
44015
What do I use for wound VAC system?? I find 97605/97606 - is this appropriate in OR?

Help?
Julie

Hello,
I don't see any partial omentecomy in the op note.
I would say 49000 for exploratory laparotomy
44603 for the 2 suture repairs on the small bowel
10021 for needle aspiration of pancreas
44015 for tube jejunostomy.

I did not check edits for these codes.

I wouldnt code for the wound vac.

Good luck.
Melissa
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Old 09-25-2009, 12:52 PM
Jarts Jarts is offline
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Melissa~
Thanks so much for your input
Julie
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