rockylopez
Networker
Good morning I have an op report that i am debating if cpt code 58160 is supported. it is not an injury to the bladder. During the csection the doctor documented that there were significant adhesions in bladder, he went in and performed a cystotomy. ANy input is appreciated. SO Far I have 59514 for the csection and I am debating on secondary cpt code to be 58160 for adhesions
Pfannenstiel skin incision was made with a scalpel and carried down through to the underlying layer of fascia with the scalpel. The
fascia was then nicked in the midline and extended laterally using the Mayo scissors. The superior aspect of the fascial incision was grasped with
the Kocher clamps and the rectus muscle dissected off sharply. This was repeated in the lower aspect of the fascial incision. The rectus muscles
were carefully dissected in the midline and the peritoneum was entered sharply and extended bluntly. An incision was made at the level of the
uterovesical peritoneum. It was then recognized that given adhesions of the bladder significantly above its normal anatomic position, a 3 cm
incision was made in the dome of the bladder; repair was deferred following delivery of the fetus and hysterotomy closure. An incision was made 3
cm above that into the lower uterine segment and extended sharply with the bandage scissors. The infant's head was then brought up to the
incision and delivered without any difficulty. The cord was clamped and cut and the infant was handed over to the waiting pediatric nurses.
Attention was then turned to the placenta which was delivered via uterine massage.
The uterus was exteriorized and cleared of all clots and debris. The uterine incision was repaired in a running locked fashion using chromic. Good
hemostasis was noted. Any areas of bleeding were addressed with figure-of-eight stitches. Attention was now turned to the repair of the
cystotomy. Both apices were grasped with the Allis clamps. The bladder mucosa was then repaired in a running fashion with 3-0 Chromic on an
SH needle. The repair was then oversown using the adventitia with 3-0 Chromic on an SH needle. The bladder was retrograde filled with sterile
milk up to 200 cc and a water-tight repair was confirmed.
The uterus was returned to the abdomen. The gutters were cleared of all clots and debris using moist laparotomy sponges. The uterine incision
was evaluated once again and noted to remain hemostatic. The rectus muscles were reapproximated in the midline together with the peritoneum.
The rectus muscles were irrigated. The fascia was reapproximated using 0 PDS. The subcutaneous tissue was then irrigated and reapproximated
in 2 layers using plain gut. The skin was closed using INSORB staples and the skin was sealed using Dermabond.
The patient tolerated the procedure well. Sponge, lap and needle counts were correct x3. The patient was taken to the recovery room in stable
condition.
Pfannenstiel skin incision was made with a scalpel and carried down through to the underlying layer of fascia with the scalpel. The
fascia was then nicked in the midline and extended laterally using the Mayo scissors. The superior aspect of the fascial incision was grasped with
the Kocher clamps and the rectus muscle dissected off sharply. This was repeated in the lower aspect of the fascial incision. The rectus muscles
were carefully dissected in the midline and the peritoneum was entered sharply and extended bluntly. An incision was made at the level of the
uterovesical peritoneum. It was then recognized that given adhesions of the bladder significantly above its normal anatomic position, a 3 cm
incision was made in the dome of the bladder; repair was deferred following delivery of the fetus and hysterotomy closure. An incision was made 3
cm above that into the lower uterine segment and extended sharply with the bandage scissors. The infant's head was then brought up to the
incision and delivered without any difficulty. The cord was clamped and cut and the infant was handed over to the waiting pediatric nurses.
Attention was then turned to the placenta which was delivered via uterine massage.
The uterus was exteriorized and cleared of all clots and debris. The uterine incision was repaired in a running locked fashion using chromic. Good
hemostasis was noted. Any areas of bleeding were addressed with figure-of-eight stitches. Attention was now turned to the repair of the
cystotomy. Both apices were grasped with the Allis clamps. The bladder mucosa was then repaired in a running fashion with 3-0 Chromic on an
SH needle. The repair was then oversown using the adventitia with 3-0 Chromic on an SH needle. The bladder was retrograde filled with sterile
milk up to 200 cc and a water-tight repair was confirmed.
The uterus was returned to the abdomen. The gutters were cleared of all clots and debris using moist laparotomy sponges. The uterine incision
was evaluated once again and noted to remain hemostatic. The rectus muscles were reapproximated in the midline together with the peritoneum.
The rectus muscles were irrigated. The fascia was reapproximated using 0 PDS. The subcutaneous tissue was then irrigated and reapproximated
in 2 layers using plain gut. The skin was closed using INSORB staples and the skin was sealed using Dermabond.
The patient tolerated the procedure well. Sponge, lap and needle counts were correct x3. The patient was taken to the recovery room in stable
condition.