tdbear612@yahoo.com
Networker
op note
Prep and drape was done in a standard sterile fashion. NG tube was also inserted. Two towel clips were applied on the umbilicus. Veress needle was inserted. Direct vision and inspection was done. There was pus noted in the pelvis, left paracolic gutter and right paracolic gutter. Everything was adherent and appendix was not visualized because everything was adherent. Therefore it was decided that we will do a lower abdominal explorative laparotomy. Abdomen was opened and pus was aspirated, it was seen that appendix was ruptured at two or three places and it came in the form of piecemeal. With the ligasure, the mesoappendix was ligated. Mesoappendix was also inflamed and thick. As I applied a clamp, so it amputated in that area, and cecum at the appendicecal junction, with the help of 2-0 vicryl, I put modified lembert sutures twice. The drain was inserted in that area, and another drain was inserted in the pelvic area and right paracolic gutter area and the third drain was inserted in the left paracolic gutter area. Abdominal cavity was washed out with copious amount of water, approximately 10 ml. All four quadrants were washed. Before washing that, it was noted that there were abscesses in the pelvis and also interloop bowel abscesses were noted. Small bowel was dilated and there was exudate on the small bowel. So small bowel run was made from the ileocecal junction. There was alot of exudate in that area Few exudate was peeled off and then washout was performed thoroughly. All the four quadrants were washed out and all the abscesses were drained between the bowel loops. Once these abscesses were drained, then washout was completed. Sponge counts were correct. Abdomen was start closing with loop PDS suture. Then skin was closed with staples and dressing was done. Plan was to put a central line, and once the central line was in, then the patient will be transferred to the ICU.
The CPT codes I had were
44960
49020
49255
But according to CCI, none of these can be billed together as they are all considered bundles. Please help.
Thank you
Prep and drape was done in a standard sterile fashion. NG tube was also inserted. Two towel clips were applied on the umbilicus. Veress needle was inserted. Direct vision and inspection was done. There was pus noted in the pelvis, left paracolic gutter and right paracolic gutter. Everything was adherent and appendix was not visualized because everything was adherent. Therefore it was decided that we will do a lower abdominal explorative laparotomy. Abdomen was opened and pus was aspirated, it was seen that appendix was ruptured at two or three places and it came in the form of piecemeal. With the ligasure, the mesoappendix was ligated. Mesoappendix was also inflamed and thick. As I applied a clamp, so it amputated in that area, and cecum at the appendicecal junction, with the help of 2-0 vicryl, I put modified lembert sutures twice. The drain was inserted in that area, and another drain was inserted in the pelvic area and right paracolic gutter area and the third drain was inserted in the left paracolic gutter area. Abdominal cavity was washed out with copious amount of water, approximately 10 ml. All four quadrants were washed. Before washing that, it was noted that there were abscesses in the pelvis and also interloop bowel abscesses were noted. Small bowel was dilated and there was exudate on the small bowel. So small bowel run was made from the ileocecal junction. There was alot of exudate in that area Few exudate was peeled off and then washout was performed thoroughly. All the four quadrants were washed out and all the abscesses were drained between the bowel loops. Once these abscesses were drained, then washout was completed. Sponge counts were correct. Abdomen was start closing with loop PDS suture. Then skin was closed with staples and dressing was done. Plan was to put a central line, and once the central line was in, then the patient will be transferred to the ICU.
The CPT codes I had were
44960
49020
49255
But according to CCI, none of these can be billed together as they are all considered bundles. Please help.
Thank you