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Hello,
I am looking for a diagnosis code to support CPT code 37617 Bilateral ligation of uterine artery.
The provider did this in addition to a 58571 Total laparoscopic Hysterectomy.
I have N93.9 Abnormal uterine bleeding.
R10.2 Pelvic pain
and N80.9 Endometriosis.
However none of these match.
Abdominal Entry
The patient was taken to the operating room where general anesthesia was administered and found to be adequate. She was placed in the Allen stirrups, prepped and draped in the usual sterile fashion. A uterus was sounded and a rumi uterine manipulator was placed in a normal fashion.
Abdominal entry was made gained using a after confirming the placement of an orogastric tube a Veress needle was placed in the left upper quadrant and starting pressure was noted to <10mmHg. The abdomen was then insufflated on high flow until15mmHg was reached. The accessory trocar sites were injected with 5ml of .25 % marcaine without epinephrine. A 5 mm trocar was then placed at the infraumbilicus. Camera was inserted and there was no evidence of blunt or sharp trauma by the trocar or the Veress needle. Lastly 5mm trocar was placed in the right and left lower quadrants lateral to the inferior epigastric arteries.
The abdomen and pelvis were then examined laparoscopically and the above findings were noted.
Ligation of Uterine Artery
The ureter was identified retroperitoneally at the bifurcation. The external and internal iliac vessels were identified and the pararectal and perivesicle spaces were developed. The obliterated umbilical artery was identifies and confirmed. The origin of the uterine artery was then identified and isolated. Surgical clips were placed at the origin of the left uterine artery. Same procedure was conducted on the right side.
Left Adnexa
The left ureter was identified along the left pelvic sidewall and found to be out of the operative field. The left fallopian tube was then grasped at the fimbria and the mesosalpinx was excised with the electrosurgical device to the level of cornua. The left round ligament was then transected and the anterior leaf of the broad ligament was the incised to the level of the bladder. The anterior leaf of the broad ligament was then extended parallel to the IP vessels and the left utero-ovarian ligament and vessels were transected. The posterior leaf of the broad ligament was incised toward the medial aspect of the uterosacral ligament exposing the uterine vessels.
Right Adnexa
The right ureter was identified along the right pelvic sidewall and found to be well out of the operative field.
The right fallopian tube was then grasped at the fimbria and the mesosalpinx was excised with the electrosurgical device to the level of cornua. The right round ligament was then transected and the anterior leaf of the broad ligament was the incised to the level of the bladder. The anterior leaf of the broad ligament was then extended parallel to the IP vessels and the right utero-ovarian ligament and vessels were transected. The posterior leaf of the broad ligament was incised toward the medial aspect of the uterosacral ligament exposing the uterine vessels.
Bladder Flap and Uterine Vessels, & Colpotomy
The bladder was elevated and the vesicouterine space was entered and the bladder flap was then further developed and the anterior colpotomy incision was made from 2 o'clock to 10 o'clock.. The uterine vessels were then coagulated and transected, and lateralized to the level of the colpotomy cup bilaterally. The colpotomy incision was then made laterally on the right and left. The posterior colpotomy was then made from 4 o'clock to 8 o'clock. The uterus was then removed through the vagina.
Vaginal Cuff Closure
The vaginal cuff was then closed running with 2-0 V-lock.
The insufflation pressure was turned decreased to less than 5mmHg and good hemostasis was observed.
The bladder was then backfilled with approximately 250ml of sterile water. The foley catheter was reomved. The trocars were then removed under direct vision. The skin incisions were then re-approximated with 4-0 monocryl. Sponge, lap, needle and instrument counts were counts were correct x 2. The patient tolerated the procedure well and was taken to the recovery room awake and in stable condition.
I am looking for a diagnosis code to support CPT code 37617 Bilateral ligation of uterine artery.
The provider did this in addition to a 58571 Total laparoscopic Hysterectomy.
I have N93.9 Abnormal uterine bleeding.
R10.2 Pelvic pain
and N80.9 Endometriosis.
However none of these match.
Abdominal Entry
The patient was taken to the operating room where general anesthesia was administered and found to be adequate. She was placed in the Allen stirrups, prepped and draped in the usual sterile fashion. A uterus was sounded and a rumi uterine manipulator was placed in a normal fashion.
Abdominal entry was made gained using a after confirming the placement of an orogastric tube a Veress needle was placed in the left upper quadrant and starting pressure was noted to <10mmHg. The abdomen was then insufflated on high flow until15mmHg was reached. The accessory trocar sites were injected with 5ml of .25 % marcaine without epinephrine. A 5 mm trocar was then placed at the infraumbilicus. Camera was inserted and there was no evidence of blunt or sharp trauma by the trocar or the Veress needle. Lastly 5mm trocar was placed in the right and left lower quadrants lateral to the inferior epigastric arteries.
The abdomen and pelvis were then examined laparoscopically and the above findings were noted.
Ligation of Uterine Artery
The ureter was identified retroperitoneally at the bifurcation. The external and internal iliac vessels were identified and the pararectal and perivesicle spaces were developed. The obliterated umbilical artery was identifies and confirmed. The origin of the uterine artery was then identified and isolated. Surgical clips were placed at the origin of the left uterine artery. Same procedure was conducted on the right side.
Left Adnexa
The left ureter was identified along the left pelvic sidewall and found to be out of the operative field. The left fallopian tube was then grasped at the fimbria and the mesosalpinx was excised with the electrosurgical device to the level of cornua. The left round ligament was then transected and the anterior leaf of the broad ligament was the incised to the level of the bladder. The anterior leaf of the broad ligament was then extended parallel to the IP vessels and the left utero-ovarian ligament and vessels were transected. The posterior leaf of the broad ligament was incised toward the medial aspect of the uterosacral ligament exposing the uterine vessels.
Right Adnexa
The right ureter was identified along the right pelvic sidewall and found to be well out of the operative field.
The right fallopian tube was then grasped at the fimbria and the mesosalpinx was excised with the electrosurgical device to the level of cornua. The right round ligament was then transected and the anterior leaf of the broad ligament was the incised to the level of the bladder. The anterior leaf of the broad ligament was then extended parallel to the IP vessels and the right utero-ovarian ligament and vessels were transected. The posterior leaf of the broad ligament was incised toward the medial aspect of the uterosacral ligament exposing the uterine vessels.
Bladder Flap and Uterine Vessels, & Colpotomy
The bladder was elevated and the vesicouterine space was entered and the bladder flap was then further developed and the anterior colpotomy incision was made from 2 o'clock to 10 o'clock.. The uterine vessels were then coagulated and transected, and lateralized to the level of the colpotomy cup bilaterally. The colpotomy incision was then made laterally on the right and left. The posterior colpotomy was then made from 4 o'clock to 8 o'clock. The uterus was then removed through the vagina.
Vaginal Cuff Closure
The vaginal cuff was then closed running with 2-0 V-lock.
The insufflation pressure was turned decreased to less than 5mmHg and good hemostasis was observed.
The bladder was then backfilled with approximately 250ml of sterile water. The foley catheter was reomved. The trocars were then removed under direct vision. The skin incisions were then re-approximated with 4-0 monocryl. Sponge, lap, needle and instrument counts were counts were correct x 2. The patient tolerated the procedure well and was taken to the recovery room awake and in stable condition.