Question cpt code 49329 or 49320

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Middletown, NY
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Hello,
Need assistance in verifying if the correct procedure performed was either 49329 or 49320, please review the below operative report.

FINDINGS: Normal Right ovary visualized. Small part of Large intestine and omentum were loosely and densely adhered to anterior abdominal wall and left sided pelvic wall. Adhesions were released with blunt and enseal devise. NO defects were observed on intestinal wall thereafter. Appendix, liver and Left hemidiaphragm were observed normal.


CONDITION: stable

DESCRIPTION OF PROCEDURE:
The patient was brought to the OR and was placed supine on the operating room table. After successful induction of anesthesia, the patient was prepped and draped with betadine in the usual sterile fashion. Her abdomen was prepped with cloroprep. She was placed in dorsal lithotomy position with flowtron stockings in place. Her bladder was catheterized and clear urine was obtained. Exam under anesthesia revealed normal external genitalia. A foley catheter was placed as well as a sponge stick in the vagina. Gloves were changed and the laparoscopy was started.
A small incision was made at the inferior aspect of the umbilicus and a Veress needle was introduced. When approximately 3 liters of carbon dioxide gas was instilled, the needle was removed and a 5 mm laparoscopic trocar and cannula were introduced through this incision. The pelvic contents were clearly visualized. Normal Right ovary visualized. Small part of Large intestine and omentum were loosely and densely adhered to anterior abdominal wall and left sided pelvic wall. A second and third incision was made, both inferior and lateral to the umbilical incision, one on the right and one on the left. 5 mm trocar and cannulas were introduced through these incisions. A grasper was placed through the left incision. Using blunt dissection and the enseal device, adhesions were released taking care of avoiding bowel injury. NO defects were observed on intestinal wall thereafter. Excellent hemostasis was noted.
All instruments were removed and the procedure was complete. Air was removed from the abdomen by gentle pressure. The cannulas were removed under direct visualization. The incisions were closed with a subcuticular stitch of 4-0 vicryl. Marcaine was injected into incisions. Good hemostasis was noted. The sponge stick was removed from the vagina and bandages were placed over the incisions. The patient was straightened on the table and was transferred to the recovery room in stable condition. Instrument, lap and sponge counts were reported as correct. Dr Rydell was my assistant and was necessary for assistance with exposure, assistance on the laparoscopy, lysis of adhesions, and closure of the abdomen.
 

csperoni

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Selden
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I would not code either 49320 or 49329. To me, this looks like laparoscopic enterolysis. Generally this is included in another procedure being done, but for this case, seems like the correct code.
44180 Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure)
 
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