Help with an op note????

herrera4

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Ok I feel like im over coding and have too many codes-which may or may not be correct any help walking me through this is appreciated!

DESCRIPTION OF PROCEDURE: ...... The 12 mm Airseal port was placed in the right lower quadrant, a 5 mm port was placed in the right mid abdomen, a 12 mm port was placed in the left lower quadrant, and a 5 mm port was placed in the left upper quadrant. Using gentle dissection the colon was mobilized. There was small bowel adherent to the colon, the area of the fistula to the bladder was taken down using meticulous sharp blunt and ligasure dissection, and no injury to the small bowel was encountered.
Next, the colon was carefully freed from the bladder.Granulation tissue was noted but no definite cystotomy was noted. A single suture of 2-0 Vicryl was then placed to approximate the peritoneum over the bladder incorporating the blader wall.
Next, the colon was mobilized from the peritoneal reflection to allow for a tension free anastomosis. Point of transection was chosen distally and the area free of diverticula and the bowel was divided using an endo GIA with a purple load. The splenic flexure was completely mobilized to the mesocolonic vessels after reflecting the omentum from the colon. The mesentery was then taken using the endo GIA with the white load, as well as LigaSure device. The left lower quadrant port site was then lengthened to approximately 4 cm. The rectus muscle was retracted medially after incising the anterior sheath and a medium wound retractor was placed, the bowel was exteriorized. Bowel was then cleared of mesentery attachments. A purse string suture of 2-0 Prolene was placed and the anvil of the 28 mm EEA was placed. The suture was tied down and the bowel was returned to the abdominal cavity. The wound protector was was then twisted 720 degrees, pneumoperitoneum was then reestablished and anastomosis was carried out in standard fashion. After completion of the anastomosis, the operating surgeon performed sigmoidoscopy, the air leak was negative at the rectal stump.
Next, using sequential dilatation of the rectal stump using the EEA sizers, we were able to advance the EEA into the colon. The EEA spike was extruded on the anterior surface of the colon, taking care to maintain a 1 cm from the staple line. The proximal colon was then docked with the endo GIA. After checking oorientation the device was closed and fired. Reinforced with sutures of 2-0 silk were in place, followed by 10 mL of Tisseel. The ostomy was then created. Dissection of subcutaneous tissue was excised in the right lower quadrant in the previously marked spot, this was carried down to the level of the fascia, which was incised in cruciate orientation. A 12 mm port was then placed through the center of the cruciate incision. The terminal ileum was identified at a point 30 cm from the ileocecal valve was chosen for the ileostomy. This was grasped with the bowel forceps and gently drawn through the abdominal wall. A window was then made in the mesentery and small Penrose drain was placed. Irrigation was then carried out, there was no bleeding noted. The ports were withdrawal under direct visualization and wounds were then closed in layers using #1 Vicryl followed by 4-0Vicryl, steristrips. The dry sterile dressing followed by Tegaderm applied. Ileostomy was then matured after placement of the appliance and the bridge in a Turnbull fashion using 3-0 Vicryl. Dry sterile dressing applied and the patient was brought back to the recovery room in stable condition. Ureteral stents were removed intact.

Thanks again
 
44661(but that's an open) then 44204 (included) and 44213(but is the mobilization included with 44661 also?) then the 44188 because the transection is included already? Im really not sure if Im even on the right path...
 
I think you need to be looking at 44205 because the ileostomy was performed. You are correct, the lysis is included so you cannot separately code that. Since the splenic flexure was mobilized or taken down you can add on code 44213.
 
44205 is ileocolostomy which was not done................look at 44207 44213 44187 for ileostomy. lysis of adhesuons is inclusive as well as closure of fistula. whenever something is resected to close fistula, fistula closure is inclusive.............
 
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