Tough Report-Please help!

[JenReyn99]

I don't know why I'm having such a hard time with this one, but if you can help, I'd very much appreciate it!

Name of Operation:
1. Extensive debulking of tumor from pelvic floor.
2. Sigmoid colectomy
3. Resection terminal ileum and cecum with primary anastomosis and colostomy, closure bladder wall, and extensive debulking of tumor.

Technique:....There was a hard mass palpable in the pelvic floor, quite fixed, not moveable, and 5 to 6 cm in size. Self-retaining retractors were placed. No peritoneal implants in this area or the remaining peritoneal cavity were obvious. Once the mass cavity was entered, it contained extensive mucoid-type material which could be debulked and evacuated manually. Dissection was continued mobilizing the rectosigmoid junction from all directions. From the lateral side, it could easily be mobilized but dense reaction was present in the midline. Posterior wall of the bladder appeared to be involved with the tumor. Once this was removed, bladder cavity could be visualized and remaining mucosa was normal. Terminal ileum was involved in this mass. It had to mobilize, and appeared to be totally disrupted involving the tumor. Tumor was also present in the surface of the cecum, possibly rising from appendix. Portion of terminal ileum which was completely involved with this mass was resected along with the tumor. The tumor implant in the cecum was also resected. Then, terminal ileum was anastomosed to ascending colon in side-to-side fashion using stapler. Oversewing was done with 4-0 silk. Rectosigmoid area had been mobilized. Proximal length was divided removing segment of colon and rectum including tumor. Distal end could not be clearly isolated because of dense reaction in the pelvic floor below rectal area. Rectal stump was closed with the continuous 3-0 Maxon in two layers, and further tissue implants were cauterized. Once as much debulking as possible with gross visualization hd been carried out, posterior wall of the bladder was repaired with continuous 2-0 vicryl. Thorough irrigation of the pelvic floor is done. End of the sigmoid colon was brought out of end colostomy in the left periumbilical area, and the bowel was then mobilized and placed in a routine fashion....

Any help is super appreciated!
I know that one of the codes will be 44160, but that's as far as my brain is going with this at the moment. I'm having trouble with the other resection.

[surgonc87]

OH MY! sounds like they should have done a HIPEC with more preoperative diagnostics, sounds malignant! Anyways, here are your codes

49205-depending on total size of tumor
44160
44143-m-59

bladder wall repair sounds iatrogenic so not reportable


MS

[JenReyn99]

Thank you so much. I was pondering those other 2 codes, but I wasn't sure that they were right. I always end up second guessing myself! Thanks for the help, I sincerely appreciate it! :0)