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Old 11-16-2010, 03:26 PM
Williealawishes Williealawishes is offline
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Default Colovesical Fistula (Sigmoid)

Hello. Can I bill 44207 for this since it is involvng low pelvic anastomosis....or do I have to use 44661 for the fistula? It just does not feel like the 44661 is as involved for the anastomosis repair and is geared more towards the small intestines.
DX 596.1

If I can use 44207 would I also include a code for repair of the bladder?

Thanks for any help in advance!!
Tracy


PREOPERATIVE DIAGNOSIS: Colovesical fistula.

PROCEDURE: Laparoscopic sigmoid colon resection and repair of bladder.

POSTOPERATIVE DIAGNOSIS: Colovesical fistula.

HISTORY: The patient is a very pleasant 60-year-old gentleman who had a
previous note of colovesical fistula and referred for same.

DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient
was taken to the operating room and placed on the operating table. After
general anesthesia had been established, the patient's abdomen was then
prepped and draped in a standard surgical fashion. A Foley catheter was
placed. A supraumbilical incision was made. The incision was carried down
through the skin and subcutaneous tissue until the fascia was reached. The
fascia was then grasped with clamps and elevated in the wound. A Veress
needle was used to insufflate the patient's abdominal cavity with 14 mmHg
pressure. After the pneumoperitoneum had been established, the 5 mm and 12
mm right lower quadrant port was then placed in a standard fashion. The
sigmoid colon was obviously inflamed and adherent to the posterior aspect
of the bladder. I then identified the mesentery of the sigmoid colon and
incised the overlying mesentery. With careful dissection I identified the
left ureter. I then divided the mesentery proximally to the point of
proximal resection as well as distally down to the rectum. I had some
difficulty mobilizing the colon off of the back wall of the bladder due to
dense adhesions from the previous inflammation. Eventually this was done
and again the ureter appeared to be left intact. I then divided the rectum
with Echelon stapler. Then I continued mobilization of the left colon in
the line of Toldt. I made a midline incision in the lower midline. I then
pulled the specimen up through this incision. I then resected the specimen,
placed a 2-0 Prolene pursestring and placed a 20 mm EEA anvil within this.
_____ was placed back in the patient's abdominal cavity. We then closed the
fascia with running looped 0 Biosyn suture. With the patient's perineum we
then advanced sequential dilators to the patient's rectum without any
difficulty. I then advanced the EEA stapler through the patient's rectum
and then fired the pin through the anterior rectal wall. It was well
visualized. After the pin had been fired through the anterior rectal wall,
I then placed the anvil on the pin and then fired the stapler without undue
difficulty. There were 2 nice concentric rings of circular tissue. The
rectum was then insufflated and the pelvis was visualized for any leaks. I
then re-gowned and gloved. Checked the abdomen for additional hemostasis
and then I removed the ports one by one. The fascia of the port just above
the umbilicus was closed with interrupted 0 Vicryl suture. The skin of all
port sites were closed interrupted 4-0 Monocryl sutures. Steri-Strips were
then applied and a clean dry dressing. The patient tolerated the procedure
well. There were no complications. Sponge and needle count correct. The
patient transferred to the recovery room, extubated in stable condition.
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