Wiki Electrocautery of sigmoid colon caused by OB-GYN

mfournier

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Hello Everyone:

Would someone be able to take a look at this op note and let me know what you think? I don't think this is 44604 maybe 49320? This was an outpatient so 44604 would not fly.

FINDINGS: A small less than 1 cm surface adjacent to the rectosigmoid junction in the retroperitoneum on the left side was oozing which was brought under hemostasis using a combination of electrocautery hook, LigaSure and Floseal. Good hemostasis at the end of the procedure.

INDICATIONS:
I was called into the operating room by Dr. XX when she was doing laparoscopic bilateral salpingo-oophorectomies for hydrosalpinx on the left side.

DESCRIPTION OF PROCEDURE:
Patient was already timed out, anesthetized, the procedure was almost completed when there was a wheezing noted on the left side next to the rectosigmoid junction and retroperitoneum.
There was adhesions posterior to the uterus, sigmoid colon, rectum. There was a lysis of adhesions and bilateral salpingo-oophorectomy which was performed already at the time of my participation in the surgery. On visual examination, there was a scar tissue with a charred tissue next to it from ligature, at the raw surface which was oozing blood. This was on the left side adjacent to the rectosigmoid junction could be a possible serosal tear or retroperitoneal tissue. It was superficial, minimal, therefore I utilized a LigaSure but it was very superficial and was difficult to grasp with the LigaSure. So, I utilized electrocautery hook and cauterized the bleeding surface on the left side of the sigmoid colon next to the previous scar tissue and retroperitoneal tissue. The bleeding completely stopped. Floseal was utilized to further reinforce the hemostasis in this area.
Patient tolerated the procedure very well.

Thank you :)
 
This is a tricky one!

I would probably use an unlisted laparoscopy code - probably 49329 or maybe 44238 -but it's not clear to me whether treatment was directed to the colon?

Another option: Did the ob-gyn list your physician as an assistant and document what your surgeon did in their op note? If so, (and if there were no other assistants) you could bill the lap bso code (looks like 58661) with 80 modifier (assuming the insurance covers an assistant surgeon w/o needing a prior auth).

*I've only been coding general surgery for 1.5 years so might not be the right track!
 
Not my wheelhouse, but I'll weigh in with my opinion here. Seems like it was a laparoscopic repair of an injury to the large intestine (states left side of the sigmoid colon). I cannot find a code for LAPAROSCOPIC large intestine repair. I would suggest the unlisted 44238 with perhaps a comparison to 44604. It does seem like less work than a 44604 as there was no "suturing". When using unlisted, I do recommend asking for input from the clinician for a code for comparable work. If that's not possible, or the clinician is not cooperative, I would compare to 44604 but not at 1:1. Maybe 60-70% of 44604??
I would not agree with 58661-80 as it seems your physician did not participate at all or was even present when the tubes/ovaries were removed.
FYI - If the ob/gyn had repaired this themselves, it would not be billable and included in the surgery. However, since your surgeon was called in for the repair, your surgeon is entitled to be compensated.
Would definitely be interested in other suggestions or confirmation!
 
Not my wheelhouse, but I'll weigh in with my opinion here. Seems like it was a laparoscopic repair of an injury to the large intestine (states left side of the sigmoid colon). I cannot find a code for LAPAROSCOPIC large intestine repair. I would suggest the unlisted 44238 with perhaps a comparison to 44604. It does seem like less work than a 44604 as there was no "suturing". When using unlisted, I do recommend asking for input from the clinician for a code for comparable work. If that's not possible, or the clinician is not cooperative, I would compare to 44604 but not at 1:1. Maybe 60-70% of 44604??
I would not agree with 58661-80 as it seems your physician did not participate at all or was even present when the tubes/ovaries were removed.
FYI - If the ob/gyn had repaired this themselves, it would not be billable and included in the surgery. However, since your surgeon was called in for the repair, your surgeon is entitled to be compensated.
Would definitely be interested in other suggestions or confirmation!
Good point - you're right, the op note does say that bso was performed before gen surgeon arrived
 
Thank you everyone for responding. I agree that the 80 on the 58661 is not a choice. I will do the unlisted and compare it to 44604 and hope for the best.
Thank you
 
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