Question Elective Left robotic laparoscopic ureteral re-implantation, neo-cystotomy, left ureteral stent exchange.

umcanes4

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Coming across a few more surgeries we are unsure of. Thank you all for your help! :)


I know this is a rob lap procedure…only code we can find is for an open one. Would we use 50949, comparable to the 50780?

Procedure Name: Elective Left robotic laparoscopic ureteral re-implantation, neo-cystotomy, left ureteral stent exchange.

Procedure Description: Pt was taken to the OR, induced under general anesthesia and then positioned in dorsal lithotomy. The pt was then repositioned into modified dorsal lithotomy position and placed in trendelenberg position. The pt was then prepped and draped. A robotic laparoscopic pelvic approach was utilized (5 ports - four 8mm ports, one 5mm port). The first port was placed using the veress needle and direct visual guidance. The remaining ports were placed under visual guidance. Attention was now focused on the left distal ureter. It was carefully dissected and ended into a scarred area near the distal ureter. The bladder was also dissected free and a site on the dome chosen for the re-impant site. The distal left ureter was then ligated with care taken to preserve the ureteral stent. A small 1cm incision was created in the bladder dome as the site for the re-implant. The distal ureter was then carefully excised till healthy ureter was reached proximally (this was then sent to pathology). The healthy proximal distal ureter was then re-anastomosed to this new bladder dome implant site using 2-0 quill sutures. A water tight anastomosis was created. The bladder was insufflated with indigo carmine tainted saline and no leak was noted. The bladder was drained. A blake drain was placed in the lower pelvis. The ports were then all removed and the wounds all closed. The skin closed was using 3-0 quill & skin glue.


Then the pt comes back in the OR the next day. This is robotic lap procedure as well. Someone suggested unlisted code comparable to 35840?


Pre-Procedure Diagnosis: Bleeding from old transected left distal ureteral stump. Hematoma in pelvis.

Procedure Name: Emergent Left robotic laparoscopic intra-abdominal exploration, hematoma evacuation, cauterization and hemostasis of old distal left ureteral stump.

Procedure Description: Pt was taken to the OR, induced under general anesthesia and then positioned in dorsal lithotomy. The pt was then repositioned into modified dorsal lithotomy position and placed in trendelenberg position. The pt was then prepped and draped. A robotic laparoscopic pelvic approach was utilized (5 ports - four 8mm ports, one 5mm port). The first port was placed using the veress needle and direct visual guidance. The remaining ports were placed under visual guidance. Attention was now focused on the pelvis. There was a large pelvic hematoma that was suctioned out. The hematoma appeared to be tracking from the old distal residual ureter stump that had been transected and clipped. Additional clips were placed and cautery was performed to achieve hemostasis. Surgisnow and arista were used to pack the area to ensure no further bleeding as well. A blake drain was placed in the lower pelvis. The ports were then all removed and the wounds all closed. The skin closed was using 3-0 quill & skin glue.
 

LMCODER

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50948 or 50947 I only read he says to preserve the stent ( this was pre-existing ? ) I do not see exchange. Also AI suggest 35840 -modifier 78 for post op bleed control.
 
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