996.73 vs 629.32

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Which ICD-9 code would you use? 996.73 vs 629.32. Do I have enough documentation for exposure of mesh into vagina or through vaginal wall?

PREOPERATIVE DIAGNOSIS:
Chronic severe pelvic pain, status post Prolift mesh insertion with secondary
scarring and mesh retraction.

POSTOPERATIVE DIAGNOSIS:
Chronic severe pelvic pain, status post Prolift mesh insertion with secondary
scarring and mesh retraction.

OPERATION PERFORMED:
Transvaginal lysis of Prolift mesh arms and cystoscopy.

OPERATIVE PROCEDURE:
After the induction of general anesthesia, the patient was placed in a full
dorsolithotomy position and was prepped and draped in the usual sterile manner.
Visual examination under anesthesia with retraction revealed no mesh erosions.
Palpation revealed a very dense contracted scar band in the apical left vaginal
wall and some scar band in the left lateral vaginal sulcus behind the pubic
symphysis. There were 2 less indurated bands in the same position on the right
side. The left apical band appeared to be approximately 2 to 3 cm distal to
the ischial spine and in the levator plate and not the obturator internus
muscle. That band was grasped with a long Allis clamp and a vertical incision
in the vaginal wall made. At that point, the Foley catheter was removed and
the bladder was inspected with a 70-degree cystoscope. Panendoscopy revealed
no mucosal abnormalities and no mesh in the bladder. Each ureteral orifice was
clearly identified. There were no urethral abnormalities noted. With traction
on the mesh arm, there was some downward deviation of the ureter but no clear
impingement on the ureter. There was clear efflux of urine from the left
ureteral orifice. The Foley catheter was then replaced and with blunt
dissection, the mesh arm was dissected down to the left pelvic sidewall and the
levator muscle. With direct tension on the mesh arm, the arm was cut with
heavy scissors. There was immediate release of the tension on the lateral
sidewall. There were 2 separate scar bands which were clearly isolated and
lysed. There was then blunt dissection carried up behind the posterior surface
of the inferior pubic ramus and the distal arm of the anterior medial Prolift
mesh was isolated and grasped with the Allis clamp. The Foley catheter was
withdrawn and cystoscopy was then performed. There appeared to be no
impingement on the ureter with traction on the anterior medial arm. The Foley
catheter was then replaced and the bladder drained. There was direct
visualization of the left anterior medial arm and this was directly lysed. The
left pelvic sidewall was then copiously irrigated and found to be hemostatic.
The vaginal incision was then closed with a running 2-0 Vicryl in a continuous
fashion. The right anterior medial band was then grasped transvaginally and a
small vertical incision made over the band in the pelvic sidewall of the
vagina. With blunt and sharp dissection, the right anterior medial band could
be clearly delineated and grasped. The Foley catheter was removed again and
the bladder inspected. There was no deviation of the ureter on the right side
with some deviation of the right lateral sidewall but no impingement or no
entry into the bladder. With the Foley catheter replaced, this band was
directly cut and clear mesh was seen in the scar band. The right posterior
lateral arm was then clearly identified at the level of the ischial spine and
was grasped with an Allis clamp and cut directly. There was adequate
hemostasis at this time after irrigation and the side wall was closed with a
running 2-0 Vicryl in a continuous fashion. At that point, the vagina was
packed. The patient was given an intravenous dose of 5 mg of Lasix with an
ampule of indigo carmine. The Foley catheter was withdrawn and the bladder
inspected. There was clear efflux of blue stained urine from each ureteral
orifice. The Foley catheter was replaced. All sponge, needle and instrument
counts were correct. The patient was awakened from general anesthesia and
returned to the recovery room in good condition.

ANESTHESIA:
General.
 
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