I was thinking 44120 and 44050. Can someone offer help please on the proper codes.
patient was taken urgently to the OR for small bowel obstruction
concerning for closed loop obstruction, possible ischemia. The patient was placed supine on the OR table. General endotracheal intubation was instituted. The abdomen was prepped and
draped in sterile fashion. A midline incision was made using a 15 blade. Deeper tissues weredissected using the cautery and Bovie. The peritoneum was entered sharply
using Metzenbaum scissors and the opening was extended cephalad and caudadusing the cautery current of the Bovie. The bowel was dilated necrotic and a
Bookwalter retractor system was used to retract the abdominal wall in opposing directions. The small bowel appeared quite ischemic and there was a
twist in the mesentery. There was a rent in the small bowel mesentery, which the remainder of the bowel had incarcerated through, become, edematous,
swollen, and stuck. There was no way to release this bowel without incisingsome of the mesentery that had entrapped. The bowel associated with the
mesentery, I incised was already necrotic. I incised some of this mesentery. Now, I was able to gently reduce the small bowel. Once the small bowel was
reduced, I was able to run it from the ligament of Treitz down to the ileocecal valve. There was approximately 2 feet of healthy bowel with area
of demarcating in the jejunum with obvious ischemic necrotic bowel. This continued on to about a foot before the ileocecal valve, which was dusky, but
not fully necrotic. I made a window between the mesentery of the bowel and bowel wall at that point distally, and transected the bowel
using a GIA-80 blue stapling device. Approximately at the line of demarcation in the jejunum, I also made a window between the small bowel and the
mesentery and transected the bowel using a GIA-80 device. The mesentery was taken with the LigaSure and any areas that bled after the LigaSure were
suture ligated with 2-0 silk suture figure-of-eight. The bowel was sent off the field for pathology. The abdomen was irrigated and dried. The colon was
examined. The stomach, spleen, liver, and all other organs and gallbladder appeared perfused and within normal limits. The patient was extremely
resuscitated and there was concern that the bowel with further demarcate. I decided to leave the patient in discontinuity and bring him back for a
second-look. After irrigating the abdomen, an ABThera device greater than 50 sq cm was used to close the abdomen and hook up to the VAC device. There
were no leaks. The patient was then left intubated and in stable critical condition and taken to the ICU for resuscitation and recovery.
patient was taken urgently to the OR for small bowel obstruction
concerning for closed loop obstruction, possible ischemia. The patient was placed supine on the OR table. General endotracheal intubation was instituted. The abdomen was prepped and
draped in sterile fashion. A midline incision was made using a 15 blade. Deeper tissues weredissected using the cautery and Bovie. The peritoneum was entered sharply
using Metzenbaum scissors and the opening was extended cephalad and caudadusing the cautery current of the Bovie. The bowel was dilated necrotic and a
Bookwalter retractor system was used to retract the abdominal wall in opposing directions. The small bowel appeared quite ischemic and there was a
twist in the mesentery. There was a rent in the small bowel mesentery, which the remainder of the bowel had incarcerated through, become, edematous,
swollen, and stuck. There was no way to release this bowel without incisingsome of the mesentery that had entrapped. The bowel associated with the
mesentery, I incised was already necrotic. I incised some of this mesentery. Now, I was able to gently reduce the small bowel. Once the small bowel was
reduced, I was able to run it from the ligament of Treitz down to the ileocecal valve. There was approximately 2 feet of healthy bowel with area
of demarcating in the jejunum with obvious ischemic necrotic bowel. This continued on to about a foot before the ileocecal valve, which was dusky, but
not fully necrotic. I made a window between the mesentery of the bowel and bowel wall at that point distally, and transected the bowel
using a GIA-80 blue stapling device. Approximately at the line of demarcation in the jejunum, I also made a window between the small bowel and the
mesentery and transected the bowel using a GIA-80 device. The mesentery was taken with the LigaSure and any areas that bled after the LigaSure were
suture ligated with 2-0 silk suture figure-of-eight. The bowel was sent off the field for pathology. The abdomen was irrigated and dried. The colon was
examined. The stomach, spleen, liver, and all other organs and gallbladder appeared perfused and within normal limits. The patient was extremely
resuscitated and there was concern that the bowel with further demarcate. I decided to leave the patient in discontinuity and bring him back for a
second-look. After irrigating the abdomen, an ABThera device greater than 50 sq cm was used to close the abdomen and hook up to the VAC device. There
were no leaks. The patient was then left intubated and in stable critical condition and taken to the ICU for resuscitation and recovery.