I've been given conflicting advice on billing out for a repair of an enterotomy occurring during a planned procedure. Would you bill out for this? Doctor wants to bill out:
44204
51860-51
dx: 560.2
POST OP DX: Intermittent sigmoid volvulus and obstructive defecation.
PROCEDURES PERFORMED:
1. Laparoscopic lysis of adhesions with partial omentectomy.
2. Laparoscopic sigmoid colectomy with handsewn primary anastomosis.
3. Repair of bladder enterotomy.
DESCRIPTION OF PROCEDURE:
In the lower pelvis the omentum was stuck down to the right lower quadrant. The sigmoid colon appeared to be volvulizing around the omentum due to its redundancy and the fixed point of the omentum. The omentum was freed up from the anterior and pelvic attachments using the harmonic scalpel. We then looked at the sigmoid colon and it was very redundant and flopping down into the pelvis and decision was made to proceed with the sigmoid colon resection. The peritoneum was scored on both the right and the left side of the sigmoid colon, down to the level of the sacral promontory and then up to the level of redundancy which was in the mid sigmoid colon. The lateral peritoneal attachments were freed up to the mid ascending colon. The mesentery was then isolated, the inferior mesenteric vessels were then clearly identified and divided using the laparoscopic GIA with a vascular load. This was done by placing the camera in the 5 mm lateral port and the stapler in the 10 mm midline port. The sigmoid was then measured to make sure we had adequate length down to the level of the sacral promontory for the resection. The mesentery was then divided up to the level of the proximal area of resection without any tension which they were. At this point decision was made to proceed with the small Pfannensiel incision to remove the sigmoid and perform the anastomosis. Small Pfannenstiel incision was made, down into the anterior abdominal cavity. On turning to the abdomen, the bladder was fixed anteriorly and a small enterotomy was made in the bladder dome, this was repaired in two layers wiht 3-0 Vicryl suture. The retractor was then put into place. The proximal and distal sigmoid were then reapproximated and decision was made to proceed with resection of the proximal rectum by placing a bowel clamp distally and amputating the proximal recturm with electrocautery. The descending colon was brought down to the proximal rectum. This was measured to length to make sure there was no tension on the anastomosis and then this was also cut with electrocautery. We then proceeded with a heandsewn two-layer anastomosis with a back row of 3-0 silks. The inner layer of 3-0 Vicryl was run from the posterior midline lateral and then a Connell stitch was used around each corner and then the full thickness running suture was run across the top. The posterior wall of 3-0 silk had previously been placed and tied. This was continued around the lateral aspect of the anastomosis and on the anterior portion of the anastomosis.
44204
51860-51
dx: 560.2
POST OP DX: Intermittent sigmoid volvulus and obstructive defecation.
PROCEDURES PERFORMED:
1. Laparoscopic lysis of adhesions with partial omentectomy.
2. Laparoscopic sigmoid colectomy with handsewn primary anastomosis.
3. Repair of bladder enterotomy.
DESCRIPTION OF PROCEDURE:
In the lower pelvis the omentum was stuck down to the right lower quadrant. The sigmoid colon appeared to be volvulizing around the omentum due to its redundancy and the fixed point of the omentum. The omentum was freed up from the anterior and pelvic attachments using the harmonic scalpel. We then looked at the sigmoid colon and it was very redundant and flopping down into the pelvis and decision was made to proceed with the sigmoid colon resection. The peritoneum was scored on both the right and the left side of the sigmoid colon, down to the level of the sacral promontory and then up to the level of redundancy which was in the mid sigmoid colon. The lateral peritoneal attachments were freed up to the mid ascending colon. The mesentery was then isolated, the inferior mesenteric vessels were then clearly identified and divided using the laparoscopic GIA with a vascular load. This was done by placing the camera in the 5 mm lateral port and the stapler in the 10 mm midline port. The sigmoid was then measured to make sure we had adequate length down to the level of the sacral promontory for the resection. The mesentery was then divided up to the level of the proximal area of resection without any tension which they were. At this point decision was made to proceed with the small Pfannensiel incision to remove the sigmoid and perform the anastomosis. Small Pfannenstiel incision was made, down into the anterior abdominal cavity. On turning to the abdomen, the bladder was fixed anteriorly and a small enterotomy was made in the bladder dome, this was repaired in two layers wiht 3-0 Vicryl suture. The retractor was then put into place. The proximal and distal sigmoid were then reapproximated and decision was made to proceed with resection of the proximal rectum by placing a bowel clamp distally and amputating the proximal recturm with electrocautery. The descending colon was brought down to the proximal rectum. This was measured to length to make sure there was no tension on the anastomosis and then this was also cut with electrocautery. We then proceeded with a heandsewn two-layer anastomosis with a back row of 3-0 silks. The inner layer of 3-0 Vicryl was run from the posterior midline lateral and then a Connell stitch was used around each corner and then the full thickness running suture was run across the top. The posterior wall of 3-0 silk had previously been placed and tied. This was continued around the lateral aspect of the anastomosis and on the anterior portion of the anastomosis.