Expl Lap, Abdom wall biospy, Ileocolonic bypass

bill2doc

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Can anyone help with CPT code please!! Thank you so much in advance.

1. Exploratory Laparotomy
2. Abdominal wall biopsy
3. Ileocolonic bypass

A midline incision was made and carried throughout the subcu fat to reveal the fascia. The fascia was incised using electrocautery, and abdom entered. Palpation of the abdom wall noted multiple peritoneal implants. further exploration noted a large firm exophytic mass coming from the right colon involving the cecum from the ileocecal junction to the hepatic flexure. The bowel was run, and there was significant amount of carcinomatosis implants noted in the mesentery of the small bowel numbered in the hundreds.

palpation in the abdom noted firmness on the left side near the root of the mesentery, note mass more extensive than originally thought and curved to involve a portion of the root of the mesentery. Palpation of the liver noted small implants over the posterior aspect of the dome of the liver, no involvement of the stomach, spleen, or gallbladder. A shave biopsy of several abdominal wall implants were taken and passed off the field as specimen.

Due to the extensiveness of the lesion and the significant carcinomatosis, the decision was made not to resect the mass but perform an ileocolonic bypass to avoid the complications of obstruction. The sites for anastomosis were identified. A side to side stapled anastomosis was then performed between distal OM and the transverse colon. The enterotomy was then closed . Abdom copiously irrigated. Hemostasis assured. Abdom closed. Skin closed, dressings applied.
 
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