Hite
Contributor
Could someone help me with this procedure which was done in addition to 47562 lap gallbladder
Op note as follows:
There is a rock-hard mass burrowing into the abdominal wall. I sued the ligasure device to divide omentum well up over the anterior surgace of the liver near the diaphram then divided omentum where it was stuck to the diaphragm all the way to the right lateral peritoneal reflection, retracted the more caudal aspect of the omentum and could visualize what appears to be a very thickened, whitish partially intrahepatic, gallbladder body. but still cannot see the infundibulum definitely or the fundus. The duodenum appears normal. Used ligasure device to free up more omentum from around where the colon appears to be invading the abdominal wall. able to better explore the colon and it appears that the hepatic flexure of the colon is adjacent to this indurated mass. but the mass itself is not colonic in origin. I retracted the proximal transverse colon and helpatic flexure caudally and was able to see where it appears to have fistulized perhaps to a very indurated fundus of the gallbladder. Once I made this window, I was able to use the blue load GIA stapler to divide this fistulous tract. In order to do so, I did upsize the subxiphoid port to a 12 mm ballon port, I then used cautery to partially excise the abdominal wass that was adherent to the fundus of the gallbladder. I used the ligasure to further divide more omentum, tethered to the fundus of the gallbladder, inflammatory mass. Once the cholecystocolic fistula was divided safely and the inflammatory mass separated from the anterior abdominal wass, I then was able to proceed with the cholecystectomy.
Can someone help code this.
I was looking at using 47562 and 47579 for unlisted lap code. Thanks for any help.
Op note as follows:
There is a rock-hard mass burrowing into the abdominal wall. I sued the ligasure device to divide omentum well up over the anterior surgace of the liver near the diaphram then divided omentum where it was stuck to the diaphragm all the way to the right lateral peritoneal reflection, retracted the more caudal aspect of the omentum and could visualize what appears to be a very thickened, whitish partially intrahepatic, gallbladder body. but still cannot see the infundibulum definitely or the fundus. The duodenum appears normal. Used ligasure device to free up more omentum from around where the colon appears to be invading the abdominal wall. able to better explore the colon and it appears that the hepatic flexure of the colon is adjacent to this indurated mass. but the mass itself is not colonic in origin. I retracted the proximal transverse colon and helpatic flexure caudally and was able to see where it appears to have fistulized perhaps to a very indurated fundus of the gallbladder. Once I made this window, I was able to use the blue load GIA stapler to divide this fistulous tract. In order to do so, I did upsize the subxiphoid port to a 12 mm ballon port, I then used cautery to partially excise the abdominal wass that was adherent to the fundus of the gallbladder. I used the ligasure to further divide more omentum, tethered to the fundus of the gallbladder, inflammatory mass. Once the cholecystocolic fistula was divided safely and the inflammatory mass separated from the anterior abdominal wass, I then was able to proceed with the cholecystectomy.
Can someone help code this.
I was looking at using 47562 and 47579 for unlisted lap code. Thanks for any help.