Korbc
Guru
Hey guys, for this surgery I was a bit torn if I can only code 49321 for this surgery. She previously had a Total hysterectomy, ovaries, uterus and and tubes removed. I choose 49321 for the peritoneal biopsies, all of this done lapro. It looked like in an NCCI edit that lysis of intestinal adhesion is included in 49321, as that's the closest I could come up as I didn't see any code for lysis of pelvic adhesion and since her ovaries, uterus and tubes are gone. For the cauterization of endometriosis I was guided to 58599, but would I code that since a hysteroscope wasn't used or would trocars/lapro be considered equivalent enough?
DIAGNOSTIC LAPAROSCOPY, LYSIS OF ADHESIONS, PERITONEAL BIOPSIES, CAUTERIZATION OF ENDOMETRIOSIS
Findings at Surgery: Endometriosis in cul-de-sac, adhesions from omentum to anterior abdominal wall and from sigmoid to left pelvic sidewall
Specimens: Peritoneal biopsies
Estimated Blood Loss: 5 ml
Drains: None
Complications: None
Condition: Stable
Description of Operative Procedure: After obtaining informed consent, the patient was brought to the operating room and general anesthesia was administered. She was prepped and draped in the usual sterile fashion. Bladder was straight-catheterized for 100 cc's of clear urine. Approximately 10 cc's of 0.5% marcaine with epinephrine were injected just superior to the umbilicus. Using the scalpel, a small skin incision was created. The 5 mm trocar was introduced under direct visualization. A survey of the anatomy revealed normal intestines beneath and omental adhesions to the anterior abdominal wall inferiorly. A 5 mm laparoscopic port was placed in the left upper quadrant by first injecting the skin with 10 cc's 0.5% marcaine with epinephrine, creating the skin incision with the scalpel, and introducing the trocar under direct visualization. Using the Ligasure, the omental adhesions were lysed. Hemostasis on the anterior abdominal wall was obtained using the monopolar scissors. The peritoneum on the right side of the abdomen was more white and opaque than the usual, so a peritoneal biopsy was performed and sent to pathology. The patient was placed in Trendelenburg and the intestines were moved cephalad with a blunt probe. There were filmy adhesions from the bowel to the cul-de-sac which I lysed with the scissors. Adhesions from the sigmoid to the left pelvic sidewall were also lysed. Two blistery areas of endometriosis on the right pelvic sidewall and cul-de-sac were removed using the peritoneal biopsy forceps and sent to pathology. Cauterization of those areas was performed to achieve good hemostasis. An area of endometriosis in the left cul-de-sac was cauterized with the monopolar cautery. As the CO2 gas was removed from the abdomen, Interceed film was placed over the anterior wall site to help prevent adhesion formation postop. Both ports were removed. The skin incisions were re-approximated with subcuticular stitches of 4-0 Monocryl. Liquid bandages were applied. Patient was extubated and brought to PACU in stable condition.
DIAGNOSTIC LAPAROSCOPY, LYSIS OF ADHESIONS, PERITONEAL BIOPSIES, CAUTERIZATION OF ENDOMETRIOSIS
Findings at Surgery: Endometriosis in cul-de-sac, adhesions from omentum to anterior abdominal wall and from sigmoid to left pelvic sidewall
Specimens: Peritoneal biopsies
Estimated Blood Loss: 5 ml
Drains: None
Complications: None
Condition: Stable
Description of Operative Procedure: After obtaining informed consent, the patient was brought to the operating room and general anesthesia was administered. She was prepped and draped in the usual sterile fashion. Bladder was straight-catheterized for 100 cc's of clear urine. Approximately 10 cc's of 0.5% marcaine with epinephrine were injected just superior to the umbilicus. Using the scalpel, a small skin incision was created. The 5 mm trocar was introduced under direct visualization. A survey of the anatomy revealed normal intestines beneath and omental adhesions to the anterior abdominal wall inferiorly. A 5 mm laparoscopic port was placed in the left upper quadrant by first injecting the skin with 10 cc's 0.5% marcaine with epinephrine, creating the skin incision with the scalpel, and introducing the trocar under direct visualization. Using the Ligasure, the omental adhesions were lysed. Hemostasis on the anterior abdominal wall was obtained using the monopolar scissors. The peritoneum on the right side of the abdomen was more white and opaque than the usual, so a peritoneal biopsy was performed and sent to pathology. The patient was placed in Trendelenburg and the intestines were moved cephalad with a blunt probe. There were filmy adhesions from the bowel to the cul-de-sac which I lysed with the scissors. Adhesions from the sigmoid to the left pelvic sidewall were also lysed. Two blistery areas of endometriosis on the right pelvic sidewall and cul-de-sac were removed using the peritoneal biopsy forceps and sent to pathology. Cauterization of those areas was performed to achieve good hemostasis. An area of endometriosis in the left cul-de-sac was cauterized with the monopolar cautery. As the CO2 gas was removed from the abdomen, Interceed film was placed over the anterior wall site to help prevent adhesion formation postop. Both ports were removed. The skin incisions were re-approximated with subcuticular stitches of 4-0 Monocryl. Liquid bandages were applied. Patient was extubated and brought to PACU in stable condition.