Would you bill for reversal only or include colectomy code too with splenic flexure mobilization?
Provider billed: 44625,44140,44139,44005
Procedure Performed
OPEN MOBILIZATION OF SPLENIC FLEXURE, LEFT URETER LYSIS, COLOSTOMY REVERSAL, COMPLETION LEFT COLECTOMY, PERASTOMAL HERNIA REPAIR, APPLICATION OF WOUND VAC
The site of entry was examined there was no bleeding or injury noted. Upon exploring the abdomen there was still significant redundant colon and significant adhesion of small bowel to colon and small bowel in the pelvis. Given this we decided to proceed with exploratory laparotomy and reversal of colostomy and completion of left colectomy. Midline incision was undertaken fascia was incised the abdomen was entered without difficulty. After extensive lysis of adhesion the remaining descending colon all the way down to the rectosigmoid junction was circumferentially dissected. The sigmoid vessels were circumferentially dissected and ligated with 0 silk. After complete mobilization of the descending colon and sigmoid all the way down to the rectosigmoid junction the rectosigmoid junction was circumferentially dissected and transected using a blue contour stapler. Then our attention turned to the splenic flexure which was fully mobilized which took an hour and 15 minutes to fully mobilize the entire splenic flexure. After complete mobilization of the splenic flexure there was significant redundant splenic flexure and the colostomy was taken down. There was a large parastomal hernia which we have repair primarily. Given significant redundant splenic flexure and transverse colon decision was also made to transect additional splenic flexure and transverse colon. After complete mobilization and transection of distal transverse colon and splenic flexure the entire transverse colon was fully mobilized and was able to reach the rectum with no tension. The transected mid transverse colon blood supply was evaluated using a spy and had very good blood supply. The abdomen was copiously irrigated adequate hemostasis obtained all fluid suctioned. A 29 EEA anvil was chosen and we proceeded with site and mid transverse colon to rectum with very good blood supply and no tension. The donuts were noted to be complete and the anastomosis was tested under fluid and no leak identified. The abdomen was further irrigated no bleeding and very good blood supply to the anastomosis was identified. Then we proceeded with primary closure of a large parastomal hernia using 1. Prolene under no tension. The midline fascia was closed with interrupted 2. Vicryl for internal retention and double-looped PDS. Given large parastomal hernia decision was made to apply a wound VAC to the large parastomal hernia wound and midline wound.
Provider billed: 44625,44140,44139,44005
Procedure Performed
OPEN MOBILIZATION OF SPLENIC FLEXURE, LEFT URETER LYSIS, COLOSTOMY REVERSAL, COMPLETION LEFT COLECTOMY, PERASTOMAL HERNIA REPAIR, APPLICATION OF WOUND VAC
The site of entry was examined there was no bleeding or injury noted. Upon exploring the abdomen there was still significant redundant colon and significant adhesion of small bowel to colon and small bowel in the pelvis. Given this we decided to proceed with exploratory laparotomy and reversal of colostomy and completion of left colectomy. Midline incision was undertaken fascia was incised the abdomen was entered without difficulty. After extensive lysis of adhesion the remaining descending colon all the way down to the rectosigmoid junction was circumferentially dissected. The sigmoid vessels were circumferentially dissected and ligated with 0 silk. After complete mobilization of the descending colon and sigmoid all the way down to the rectosigmoid junction the rectosigmoid junction was circumferentially dissected and transected using a blue contour stapler. Then our attention turned to the splenic flexure which was fully mobilized which took an hour and 15 minutes to fully mobilize the entire splenic flexure. After complete mobilization of the splenic flexure there was significant redundant splenic flexure and the colostomy was taken down. There was a large parastomal hernia which we have repair primarily. Given significant redundant splenic flexure and transverse colon decision was also made to transect additional splenic flexure and transverse colon. After complete mobilization and transection of distal transverse colon and splenic flexure the entire transverse colon was fully mobilized and was able to reach the rectum with no tension. The transected mid transverse colon blood supply was evaluated using a spy and had very good blood supply. The abdomen was copiously irrigated adequate hemostasis obtained all fluid suctioned. A 29 EEA anvil was chosen and we proceeded with site and mid transverse colon to rectum with very good blood supply and no tension. The donuts were noted to be complete and the anastomosis was tested under fluid and no leak identified. The abdomen was further irrigated no bleeding and very good blood supply to the anastomosis was identified. Then we proceeded with primary closure of a large parastomal hernia using 1. Prolene under no tension. The midline fascia was closed with interrupted 2. Vicryl for internal retention and double-looped PDS. Given large parastomal hernia decision was made to apply a wound VAC to the large parastomal hernia wound and midline wound.