Question Elective Right robotic ligation of gonadal vessels and ureterolysis

umcanes4

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Hello all! Hoping someone can help or guide us in the right direction. Coming across a surgery we have never coded and kinda stumped. We were doing some research and coming up with:

Use an unlisted 50949 code for the robotic lap ureterolysis compared to 50715
Use an unlisted 53899 code for the nephropexy compared to 50045 or also came across an article referencing maybe using 50400-52
We are having trouble finding a code for the ligation of gonadal vessels.

Thanking you in advance!


Pre-Procedure Diagnosis: Right ureteral obstruction from crossing gonadal vessels, Right hypermobile kidney.

Post-Procedure Diagnosis: Same as pre-procedure diagnosis.

Procedure Name: Elective Right robotic ligation of gonadal vessels and ureterolysis. Right robotic nephropexy.

Procedure Description: Pt was taken to the OR, placed in supine position and induced under general anesthesia. Pt was then repositioned in right lateral flank position and prepped & draped in standard surgical fashion. A robotic laparoscopic intra-abdominal approach was used. Initial access was obtained using a veress needle and direct visual port placement, the remaining ports were all placed under direct vision. A total of 6 ports were used - two 5mm port and four 8mm ports. Attention was now focused on the right renal bed, the ascending colon was reflected medially and the right ureter and gonadal vessels were dissected free. The gonadel vessels could be seen twisted around the ureter twice and this appeared to be causing some relative obstruction of the ureter. Given the pt's history of a hysterectomy, it was felt safest to simply ligate the gonadal vessels to preserve the ureter intact and ensure no obstruction of the ureter. The ureter was completely freed. The hypermobile kidney was then also fixed using a robotix nephropexy technique. The densely adherent adventitia of the kidney was attached to the hepato-transversus abdominus triangular ligament using five weck hemo-lock clips. The kidney appeared superiorly and lateral fixed and not mobile. A drain was placed in the lateral bed. The instruments were removed and the ports closed.

The ports were closed with cellerate, 3-0 quill sutures & steri-strips for the skin closure for all incisions.

The pt was then extubated and transferred to PACU/recovery in stable condition
 
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