rockylopez
Networker
hello everyone. I wanted to see if anyone can give me some insight on this surgery. I coded it as a 59151 with icd 10 code o00.101. blue cross denied the claim, stating that the cpt code is not covered with icd 10. If anyone can let me know if the code I used is not correct please let me know. I appreciate it.
PREOPERATIVE DIAGNOSES:
1. Ruptured right ectopic pregnancy
2. Hemoperitoneum
NAME OF PROCEDURE: Diagnostic Laparoscopy, Right Salpingectomy, evacuation of hemoperitoneum
FINDINGS: At least 1 L of hemoperitoneum inside the abdomen, large right ectopic pregnancy, normal liver edge, normal left tube, normal bilateral ovaries, right ureter seem vermiculating well below removal site of ectopic pregnancy
COMPLICATIONS: None.
DRAINS: Foley catheter.
SPECIMENS: right ectopic pregnancy
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken back to the operating room where patient was appropriately anesthetized with the GETA anesthesia. The patient was then prepared and draped in normal sterile fashion in dorsal lithotomy position. A timeout was performed and noted to be correct.
Weighted speculum and a right angle were inserted into the vagina. Cervix grasped with tenaculum and hystometer used to measure uterine cavity. It was found to be 6 cm . Cervix was dilated gradually and uterine manipulator set to 6 cm was inserted into the uterus and balloon filled. Removed tenaculum, speculum and right angle from the vagina. Foley already in place. Surgeon changed gloves and proceeded to perform laparoscopy. 5 mm incision was made in the infra umbilicus. 5 mm port with camera were placed under direct laparoscopy. Intra-abdominal placement confirmed with drop in pressure and ability to visualize the liver. Pelvis inspected and above-noted findings were noted.
RLQ incision made with scalpel and 8 mm trocar inserted under direct visualization. Steps repeated on LLQ to place a 5 mm trocar..
Ruptured right fallopian tube was grasped with atraumatic grasper and lifted out of the pelvis. Harmonic used to cauterize and remove the fallopian tube.. Hemostasis was found to be excellent. Pelvis irrigated and clots removed. 8mm Endobag was inserted in place of the 8 mm trocar. Bag deployed into abdomen and specimen was placed in endobag under direct visualization. Endobag closed and removed with trocar through trocar incision site. Specimen removed piecemeal out of bag w/ kocher clamp until entire bag able to be removed. 8 mm trocar replaced. Will send to pathology. Pelvis inspected again and no active bleeding noted. Small clots unable to be fully removed. Pelvis once again irrigated and suctioned which took up the majority of the surgical time. Pneumoperitoneum deflated under direct visualization no abnormalited noted. All trocars removed. All port sites closed with 4 Monocryl. Dermabond placed on all port sites.
Uterine manipulator and foley removed. No active bleeding noted from area where the tenaculum had been placed. Patient tolerated the procedure well and was taken to the recovery room in stable condion.
Count complete x3
PREOPERATIVE DIAGNOSES:
1. Ruptured right ectopic pregnancy
2. Hemoperitoneum
NAME OF PROCEDURE: Diagnostic Laparoscopy, Right Salpingectomy, evacuation of hemoperitoneum
FINDINGS: At least 1 L of hemoperitoneum inside the abdomen, large right ectopic pregnancy, normal liver edge, normal left tube, normal bilateral ovaries, right ureter seem vermiculating well below removal site of ectopic pregnancy
COMPLICATIONS: None.
DRAINS: Foley catheter.
SPECIMENS: right ectopic pregnancy
DESCRIPTION OF PROCEDURE: After informed consent was obtained, the patient was taken back to the operating room where patient was appropriately anesthetized with the GETA anesthesia. The patient was then prepared and draped in normal sterile fashion in dorsal lithotomy position. A timeout was performed and noted to be correct.
Weighted speculum and a right angle were inserted into the vagina. Cervix grasped with tenaculum and hystometer used to measure uterine cavity. It was found to be 6 cm . Cervix was dilated gradually and uterine manipulator set to 6 cm was inserted into the uterus and balloon filled. Removed tenaculum, speculum and right angle from the vagina. Foley already in place. Surgeon changed gloves and proceeded to perform laparoscopy. 5 mm incision was made in the infra umbilicus. 5 mm port with camera were placed under direct laparoscopy. Intra-abdominal placement confirmed with drop in pressure and ability to visualize the liver. Pelvis inspected and above-noted findings were noted.
RLQ incision made with scalpel and 8 mm trocar inserted under direct visualization. Steps repeated on LLQ to place a 5 mm trocar..
Ruptured right fallopian tube was grasped with atraumatic grasper and lifted out of the pelvis. Harmonic used to cauterize and remove the fallopian tube.. Hemostasis was found to be excellent. Pelvis irrigated and clots removed. 8mm Endobag was inserted in place of the 8 mm trocar. Bag deployed into abdomen and specimen was placed in endobag under direct visualization. Endobag closed and removed with trocar through trocar incision site. Specimen removed piecemeal out of bag w/ kocher clamp until entire bag able to be removed. 8 mm trocar replaced. Will send to pathology. Pelvis inspected again and no active bleeding noted. Small clots unable to be fully removed. Pelvis once again irrigated and suctioned which took up the majority of the surgical time. Pneumoperitoneum deflated under direct visualization no abnormalited noted. All trocars removed. All port sites closed with 4 Monocryl. Dermabond placed on all port sites.
Uterine manipulator and foley removed. No active bleeding noted from area where the tenaculum had been placed. Patient tolerated the procedure well and was taken to the recovery room in stable condion.
Count complete x3