Colectomy

KBean2018

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Hello, would you code the below as 44204? I see that the terminal ileum was released, so I didn't know if I should lean toward 44205. Thanks in advance for any help

In the supine position with appropriate monitoring she received general anesthesia with IV antibiotic. Foley catheters placed. Nasogastric tube was placed and ultimately removed. The depth of her panniculus precludes TAP blocks initially and this ultimately completed at the end of the operation with a different transducer. At least for now the abdomen is widely prepped with chlorhexidine draped after 3 minutes. A 7 cm incision was made about a third cephalad from the umbilicus. The thick adipose tissue was divided and the abdomen is entered. GelPort is placed with a dry laparotomy pad, CO2 insufflation and abdominal exploration. Using the Enseal, the gastrocolic omentum is divided in the lesser sac opened. We separate off the gallbladder into the right side releasing the lateral attachments including the terminal ileum with the appendix. I am now able to eviscerate but the adipose tissue precludes safe exposure of the middle colic in the right colic vessels. So, I extend the incision and additional 8 cm cephalad, now a 15 cm incision. With a rolled laparotomy pad at the small bowel mesentery, the right transverse colon can be transilluminated and I used the Enseal to divide the right branch of the middle colic artery and vein. The corresponding mesentery is divided and the colon divided with a green load stapler. The remainder the mesentery is released until I encircled the origin of the right colic vessels, divided with a single application of the white vascular load stapler. The remainder the mesentery is divided to the small bowel which is divided with blue load stapler and the specimen is removed. I now approximate the seromuscular small bowel with free tinea and open the corresponding staple lines and an anastomosis is created with the 65 mm blue load stapler. The mucosa is pink, re-attached with Allis clamps and the enterotomies are closed, in line with the original staple lines, using a single application of the TA 60 stapler, blue load. All instruments and laparotomy pads are sought and accounted for, gloves were exchanged. The two mesenteric leaves are approximated with running locked 2-0 silk suture. The right omentum had been removed, the left is allowed to lay beneath the abdominal incision and the procedure was terminated. The midline fascia is closed with #1 Maxon suture anchored above and below and tied centrally. The soft tissue is irrigated with saline and skin closed with staples
 

blckjnpr

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The surgeon notes "remainder the mesentery is divided to the small bowel which is divided', so with that and the release of the terminal ileum with the appendix, I would choose 44205.
 
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