Coding Case Study:
Knock Out These 3 Challenges for Endometrial Cancer Surgery
Published on Sat Jan 14, 2006
Hint: Find out whether your ob-gyn performed a limited or complete lymphadenectomy If your ob-gyn treats a patient with endometrial cancer, you-ll find that procedure codes specific to this complicated type of surgery are hard to come by.
Read the following op note and see what steps our experts recommend you take when you tackle these three challenges: deciding whether the ob-gyn converted a laparoscopic to an open procedure, finding a code for a partial omentectomy, and asking your ob-gyn questions about the lymphadenectomy. First, Read Over This Op Note Preoperative diagnosis: Adenocarcinoma of the endometrium.
Postoperative diagnosis: Same as above, but greater than 50 percent myometrial invasion, pathology pending.
Operation performed: Laparoscopic assisted transvaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy, laparotomy with pelvic and periaortic node dissection, partial omentectomy, pelvic washings.
Procedure: Exam of the pelvic organs revealed an eight-week-size uterus. The right and left ovaries appear to be within normal limits. The ob-gyn found no evidence of excrescences or signs of metastatic disease in the lower pelvis along the bowel or serosa, nor did he discover evidence of metastatic disease in the upper abdomen, liver and dome of the diaphragm. He then performed a dissection.
He removed the uterus vaginally with the assistance of the laparoscope, and the pathologist was present to open the organ and render an opinion.
The pathologist saw an enlarged, fungating, relatively superficial lesion of the endometrium. Up in the patient's right fundal area, however, the pathologist saw an invasion of the myometrium at least two-thirds of the way through. So the ob-gyn performed a laparotomy and pelvic node dissection. He removed the laparoscope and made a new incision to enter the peritoneum. He obtained pelvic washings from the right cul-de-sac and pelvic area. He then performed a partial omentectomy with the aid of multiple Kelly clamps.
The ob-gyn did a pelvic node dissection, first on the right side identifying the ureter evenly. He carried down the dissection to include the internal and external iliac lymph nodes. He performed the same procedure on the left side. The dissection took place below the bifurcation of the aorta. The ob-gyn obtained tissue in the periaortic lymphatic chain area. Coding Challenge 1: Consider the LAVH The first thing you must do is decide whether your ob-gyn used two different surgical approaches--laparoscopic and abdominal.
Read the op note one more time. Keep in mind: -Laparoscopic- means that the ob-gyn used a scope- assisted technique with a small incision, says LaRonda Ford, CCS-P, accounts receivable specialist at Memphis Internal Medicine PLLC in Memphis, Tenn. -Laparotomy- means that the ob-gyn made an incision into the abdominal wall.
Answer: The ob-gyn did not complete the procedure via laparotomy but, rather, performed an additional procedure abdominally separate [...]
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