Wiki Exploratory laparotomy abdominal pregnancy CPT assistance

[dmarshall]

Hello OB/GYN coding group,

Doctor removed abdominal pregnancy and left tube in which the placenta appeared to be attached to, my question is if my coding choice is correct to bill out CPT code 59130 & 58720-51. Please see Op report with path below:

Specimens: Pregnancy found to be in abdominal cavity, inspected and found to have grossly normal morphology, c/w 12w fetus. Dilated and ruptured left tube. Dilated right fallopian tube, appears to be from oxidized blood. Normal appearing uterus and right ovary. Procedure Details: The site of surgery properly noted. The patient was taken to Operating Room. A Time Out was held and the above information confirmed. The patient was taken to the OR with IV fluid running. SCDs placed on bilateral lower extremities. Two grams of cefazolin (Ancef) were given for infection prophylaxis. General anesthesia obtained without difficulty. The patient prepped and draped in supine position in normal sterile fashion. Foley catheter was inserted and bladder was emptied. Pfannenstiel skin incision was made with the scalpel and incision was carried down to the fascia with sharp dissection. Fascia was incised and then extended. Preperitoneal fatty tissue was bluntly dissected to expose peritoneum. The peritoneum was entered and incision was extended superiorly and inferiorly to the bladder reflection. Extensive hemoperitoneum was noted immediately on entry. Once enough blood was suctioned out to allow visibility, bowel was packed with moist lap sponges. Pt was placed in slight Trendelenburg. The fetus, consistent with 12w gestation, was noted within the hemoperitoneum. Left tube appeared grossly ruptured. Placenta was removed in what appeared to be its entirety from its attachment within the left tube. Left ovary was not visualized; however, from what appeared to be the IP ligament, two Carmalt clamps were placed to the cornua, including the fallopian tube. A free tie and a Heaney stitch were placed to suture ligate the pedicle. A small area of bleeding was noted on an epiploic appendage, treated with brief usage of Bovie. Out of an abundance of concern for proximity to the bowel, few figure of eight stitches were placed in this area to ensure integrity of the area. This was then noted to be hemostatic following extensive inspection of the bowel with no signs of perforation. At this time, two Kochers were placed on the cornua of the uterus to facilitate retraction. An area of denuded peritoneum was noted on the left aspect of the posterior cul-de-sac. Surgicel was initially placed followed by five minutes of compression with a sponge stick. Arista was then placed followed by an additional few minutes of compression with a sponge stick. Area was noted to be completely hemostatic. Hemostasis was observed. The blood clots and fluid were wiped out of the abdomen and pelvis with moist laparotomy sponges. The peritoneum and muscle layers were closed together with horizontal mattress sutures, taking care to avoid the distended bowel. The fascial layer was closed in a running fashion. The skin was closed with suture in a subcuticular fashion. Instrument, sponge, and needle counts were correct prior the abdominal closure and at the conclusion of the case. The patient was taken to the recovery room in stable condition. Disposition: PACU - hemodynamically stable. Condition: stable Attending present for entire procedure

DIAGNOSIS Left fallopian tube, and portion of ovary: Ruptured left fallopian tube associated with placental tissue and fetus. Consistent with ectopic pregnancy, clinical. Portion of ovarian tissue with organizing hemorrhage. See microscopic description. * MICROSCOPIC DESCRIPTION The specimen shows disrupted fallopian tube and ovary with adherent and separate fragments of placental tissue. The fetal measurements are consistent with 13 week gestation.

Thank you for reviewing this report!

 

[csperoni]

The codes are not CCI edits and it does appear to me that both were performed.
Hopefully someone with more ob experience can confirm.

 

[dmarshall]

The codes are not CCI edits and it does appear to me that both were performed.
Hopefully someone with more ob experience can confirm.

My thoughts too, I wasn't sure if I should add a modifier 22 to the 59130 since the pregnancy was an abdominal pregnancy and the tube was attached to the placenta causing removal. Thank you for your help, appreciate it your response.