Wiki Foreign body removal abdominal

[debellis59]

Patient had RLQ pain, and was suspected to have filshie clips adherent to her right abdominal sidewall.

The abbreviated note reads: Each skin incision os proceeded with injection of marcaine. Supraumbilical transverse incision was made with a scalpel. A Veress needle was inserted into the abdominal cavity. Drop test was consistent with entry in the abdominal cavity and C)2 was insufflated under low pressure. The Veress needle was replaced with 8 mm robot port. The robot camera was inserted into the abdominal cavity with findings as listed above (lt tube surgically absent, staple lines from prior hysterectomy, rt pelvis free of adhesions, FB (suspected filshie clips) adherent to rt abdominal sidewall)).

Gen surgery intraop consult was requested to address the rt abdominal wall FB. Add'l 5 mm ports x 2 were placed in the left abdomen. The gen surgeon dissected and removed the foreign bodies which were sent to pathology. Irrigation and suctioning were performed. Monopolar cautery was used to improve hemostasis. Gen surgeon scrubbed out.

Floseal 10 ml was placed at the site of foreign body removal. Sheet of Interceed was placed over the site of dissection. Instruments removed. CO2 allowed to escape ... stitched up. Yes, a bit abbreviated.

I'm thinking that my provider (the OBGYN) would only bill for the diagnostic laparoscopy. Would this be correct as she didn't do the actual FB removal?

Any help is appreciated.

 

[nielynco]

Patient had RLQ pain, and was suspected to have filshie clips adherent to her right abdominal sidewall.

The abbreviated note reads: Each skin incision os proceeded with injection of marcaine. Supraumbilical transverse incision was made with a scalpel. A Veress needle was inserted into the abdominal cavity. Drop test was consistent with entry in the abdominal cavity and C)2 was insufflated under low pressure. The Veress needle was replaced with 8 mm robot port. The robot camera was inserted into the abdominal cavity with findings as listed above (lt tube surgically absent, staple lines from prior hysterectomy, rt pelvis free of adhesions, FB (suspected filshie clips) adherent to rt abdominal sidewall)).

Gen surgery intraop consult was requested to address the rt abdominal wall FB. Add'l 5 mm ports x 2 were placed in the left abdomen. The gen surgeon dissected and removed the foreign bodies which were sent to pathology. Irrigation and suctioning were performed. Monopolar cautery was used to improve hemostasis. Gen surgeon scrubbed out.

Floseal 10 ml was placed at the site of foreign body removal. Sheet of Interceed was placed over the site of dissection. Instruments removed. CO2 allowed to escape ... stitched up. Yes, a bit abbreviated.

I'm thinking that my provider (the OBGYN) would only bill for the diagnostic laparoscopy. Would this be correct as she didn't do the actual FB removal?

Any help is appreciated.

Yes, you can bill just 49320 or you can check to see what code the general surgeon billed and go in as co-surgeons (but you both have to do it). But there is no code for removal of a foreign body via a laparoscope so keep it simple on your end and just bill 49320.