mfournier
Networker
Hello Everyone:
On the following op note, would you give credit for 44650 or 44661 or should the only thing to code be 44143
Preoperative diagnosis: Perforated diverticulitis with abscess and colovaginal fistula
Postoperative diagnosis: Same
Procedure: Hartmann's procedure, repair of colovaginal fistula, drainage of intra-abdominal abscess
Findings: Perforated diverticulitis with a large intra-abdominal abscess and a small colovaginal fistula
Procedure: The procedure was performed in the operating room. The patient was transferred to the operative table in the supine position. The patient was prepped and draped in standard surgical fashion. A midline incision was made from above the umbilicus to the pubic symphysis and carried down through the skin, subcutaneous tissues, to and through the fascia to the peritoneum with the Bovie cautery. Upon entering the abdomen, the sigmoid colon was folded down into the pelvis between the bladder and the uterus. The bowel was packed away and the sigmoid colon was mobilized with a combination of blunt, sharp, electrocautery dissection techniques. The area of the fistula was found. The fistula was transected with the Bovie cautery. There was copious pus coming from the fistula. The rectum was then mobilized as well, and the rectum was transected with a contour stapler. An area proximal to the fistula was chosen and the colon resected, again with a stapler. The mesentery was taken down with the LigaSure vessel sealing device. The specimen was passed off. The abscess cavity was then opened, drained, and curetted of hypergranulation tissue. There was vegetable matter in the abscess. The small area of the colovaginal fistula was identified as well. The abscess cavity was cauterized. The percutaneous drain placed by radiology was removed by cutting its pigtail suture removing it from the entrance site. A new 10 JP drain was then tunneled from a separate stab wound in the right lower quadrant with a Schnidt. The abscess cavity and the abdomen were irrigated and the irrigant was suctioned. The proximal colon was brought out through a defect made in the rectus, after removing a disc of skin. It was matured in a Brooke fashion after closing the abdomen. The abdomen was closed with a #1 PDS in a running continuous manner. The skin was stapled. The wound was dressed with a Prevena dressing. The ostomy appliance was placed. The patient tolerated the procedure well. All sponge, needle and instrument counts were correct at the end of the case. And I was present throughout the entirety of the case.
Path:
Final Diagnosis
Sigmoid colon, colectomy:
-Perforated diverticulitis, two foci, with associated peri-diverticular abscesses and fat necrosis
-Diverticulosis
-The resection margins appear viable
-Reactive lymph nodes
Any guidance would be awesome
Thank you
MF
On the following op note, would you give credit for 44650 or 44661 or should the only thing to code be 44143
Preoperative diagnosis: Perforated diverticulitis with abscess and colovaginal fistula
Postoperative diagnosis: Same
Procedure: Hartmann's procedure, repair of colovaginal fistula, drainage of intra-abdominal abscess
Findings: Perforated diverticulitis with a large intra-abdominal abscess and a small colovaginal fistula
Procedure: The procedure was performed in the operating room. The patient was transferred to the operative table in the supine position. The patient was prepped and draped in standard surgical fashion. A midline incision was made from above the umbilicus to the pubic symphysis and carried down through the skin, subcutaneous tissues, to and through the fascia to the peritoneum with the Bovie cautery. Upon entering the abdomen, the sigmoid colon was folded down into the pelvis between the bladder and the uterus. The bowel was packed away and the sigmoid colon was mobilized with a combination of blunt, sharp, electrocautery dissection techniques. The area of the fistula was found. The fistula was transected with the Bovie cautery. There was copious pus coming from the fistula. The rectum was then mobilized as well, and the rectum was transected with a contour stapler. An area proximal to the fistula was chosen and the colon resected, again with a stapler. The mesentery was taken down with the LigaSure vessel sealing device. The specimen was passed off. The abscess cavity was then opened, drained, and curetted of hypergranulation tissue. There was vegetable matter in the abscess. The small area of the colovaginal fistula was identified as well. The abscess cavity was cauterized. The percutaneous drain placed by radiology was removed by cutting its pigtail suture removing it from the entrance site. A new 10 JP drain was then tunneled from a separate stab wound in the right lower quadrant with a Schnidt. The abscess cavity and the abdomen were irrigated and the irrigant was suctioned. The proximal colon was brought out through a defect made in the rectus, after removing a disc of skin. It was matured in a Brooke fashion after closing the abdomen. The abdomen was closed with a #1 PDS in a running continuous manner. The skin was stapled. The wound was dressed with a Prevena dressing. The ostomy appliance was placed. The patient tolerated the procedure well. All sponge, needle and instrument counts were correct at the end of the case. And I was present throughout the entirety of the case.
Path:
Final Diagnosis
Sigmoid colon, colectomy:
-Perforated diverticulitis, two foci, with associated peri-diverticular abscesses and fat necrosis
-Diverticulosis
-The resection margins appear viable
-Reactive lymph nodes
Any guidance would be awesome
Thank you
MF