rockylopez
Networker
Hello! Thank you for taking time to read my post. I am coding for a hospitalist physician that did not perform the csection but the patients went to hospital 4 days after her csection delivery (another provider not in the group delivered and delivered in another hospital). Upon reviewing the op report I am gearing towards CPT code 35840, i just wanted to get anyones thoughts. Thank you.
Procedure Performed: Exploratory laparotomy, hematoma evacuation and pelvic irrigation
Specimen: none
Findings: 2 large pelvic hematoma collections, one was anterior to the abdominal rectus, second was posterior to the abdominal rectus but anterior to the uterus. No definitive bleeding site however dissected area appeared friable.
After anesthesia was administered, she was placed in a dorsal lithotomy position and the abdomen was prepped and draped in the usual sterile fashion for abdominal delivery. A transverse skin incision was made overlying previous incision, and carried through to the underlying layer of fascia with the scalpel. The fascial sutures were removed. Immediately present subfascially and anterior to the rectus muscles was a large hematoma blood clot collection. This area was irrigated and blood clots removed. The rectus muscles were bluntly divided in the midline revealing a deeper hematoma collection anterior to the uterus. After this area was irrigated and his clots were removed and Alexis retractor was placed. The anterior uterus was examined in its entirety revealing only friable tissue. The hysterotomy was found to be intact. The bilateral pericolic gutters were irrigated and any remaining clot was removed. Pressure was used to achieve hemostasis on the uterus. Surgicel was placed in the anterior lower uterine segment and Arista was used to spray around any remaining areas that appeared friable.
The fascia was closed with 0 looped PDS in a running fashion. The subcutaneous tissue was reapproximated with 2-0 Vicryl CT-1. The skin was re-approximated carefully with INSORB staples. Steri-Strips were placed and a sterile dressing was placed. Hemostasis was noted at all levels. The patient tolerated the procedure well and was transported to the recovery room in satisfactory condition. Final sponge and instrument counts were correct x 4.
Procedure Performed: Exploratory laparotomy, hematoma evacuation and pelvic irrigation
Specimen: none
Findings: 2 large pelvic hematoma collections, one was anterior to the abdominal rectus, second was posterior to the abdominal rectus but anterior to the uterus. No definitive bleeding site however dissected area appeared friable.
After anesthesia was administered, she was placed in a dorsal lithotomy position and the abdomen was prepped and draped in the usual sterile fashion for abdominal delivery. A transverse skin incision was made overlying previous incision, and carried through to the underlying layer of fascia with the scalpel. The fascial sutures were removed. Immediately present subfascially and anterior to the rectus muscles was a large hematoma blood clot collection. This area was irrigated and blood clots removed. The rectus muscles were bluntly divided in the midline revealing a deeper hematoma collection anterior to the uterus. After this area was irrigated and his clots were removed and Alexis retractor was placed. The anterior uterus was examined in its entirety revealing only friable tissue. The hysterotomy was found to be intact. The bilateral pericolic gutters were irrigated and any remaining clot was removed. Pressure was used to achieve hemostasis on the uterus. Surgicel was placed in the anterior lower uterine segment and Arista was used to spray around any remaining areas that appeared friable.
The fascia was closed with 0 looped PDS in a running fashion. The subcutaneous tissue was reapproximated with 2-0 Vicryl CT-1. The skin was re-approximated carefully with INSORB staples. Steri-Strips were placed and a sterile dressing was placed. Hemostasis was noted at all levels. The patient tolerated the procedure well and was transported to the recovery room in satisfactory condition. Final sponge and instrument counts were correct x 4.
