amy_mousie
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PROCEDURES:
1. Exploratory laparoscopy with splenic flexure mobilization
2. Sigmoid resection with primary anastomosis.
3. Lysis of adhesions.
4. Primary ureteral repair of over 60 frensh double J 20 cm ureteral stent
DESCRIPTION OF PROCEDURE:
iNITIALLY, WE MADE A SUPRAUMBILICAL INCISION WITH 11 BLADE SCALPEL AND USED VERESS NEEDLE TO OBTAIN PNEUMOPERITONEUM TO 15 MMhG. lAPAROSCOPE WAS INTRODUCED TO EVALUATE FOR VISCERAL VASCULAR INJURY. NONE WAS SEEN. LAPAROSCOPY WAS PREFORMED.
Patient noted to have significant adhesions to her anterior abdominal wall just above where we had placed our trocar with also obvious mesh with tacking. We identified her sigmoid colon which was significantly adhesed to the side wall as well as to her adnexal structures including her uterus. Tried to dissect the plane to free the colon from the both sidewalls and her uterus. Very difficult dissection and photodocumentation was preformed of this. We were able to completely mobilize the colon away from the sidewall of the adnexal structures. I went ahead and mobilized the colon up along the white line of the Toldt all the way to the splenic flexure. Once this was completed, we careflly identified in the retroperitoneum, and ureter. Did normal peristalsis. We preformed open colon resection at this point.
Patient's pneumoperitoneum was released. We made a lower midline vertical incision approximately 8 cm in length. Dissected down through fat/subcutaneous tissue. Opened fascia lengthwise then opened the peritoneum at the length of the incision. We progressively tried to bring the adhesed and diseased colon up into the wound. There was stilll significant amount of inflammation to the lateral sidewall inferiorly. We dissected this down. In the process the cautery did partially transected the ureter. We went ahead and finished our mobilization of her colon and used Echelon 60-mm stapler to transect the colon both proximally and distally using the Ace Harmonic to take down adjoining mesentery. We performed our bowel anastomosis sisde to side functional end to end anastomosis was done. Did a handsewn the common enterotomy closed as there was modest amount of tension on the anastomosis. Once this was complete hemostasis I attended the ureter. Placed a finger under the ureter which had been fairly well skeletonized during the dissection. It was very clear partial injury to it. We inject indigo carmine intravascularly and this was confirmed with blue dye indicating that the right side of the ureter was functional as well as we had indigo carmine through our structure confirming that this was the ureter. With assistance from Dr._________________we repaired this.
Once the ureter repair was complete we irrigated thoroughly and assessed for hemostatsis. Closure of wond was done and dressings were placed.
HOSPITAL CODES: 45.76, 45.94, 56.82, 54.59, 59.8
CPT CODES: I am crossing between 44130 or 45550 Sigmoid resection with primary amastomosis.
45820-45825 Primary ureteral repair
44139 Laparoscopy with splenic flexure mobilization
ANY ASSISTANCE WITH CPT CODING WOULD BE APPRECIATED. THANK YOU SO MUCH
Amy Wright
CPC-H, CCP-H, CPC, CCP, CMBS
1. Exploratory laparoscopy with splenic flexure mobilization
2. Sigmoid resection with primary anastomosis.
3. Lysis of adhesions.
4. Primary ureteral repair of over 60 frensh double J 20 cm ureteral stent
DESCRIPTION OF PROCEDURE:
iNITIALLY, WE MADE A SUPRAUMBILICAL INCISION WITH 11 BLADE SCALPEL AND USED VERESS NEEDLE TO OBTAIN PNEUMOPERITONEUM TO 15 MMhG. lAPAROSCOPE WAS INTRODUCED TO EVALUATE FOR VISCERAL VASCULAR INJURY. NONE WAS SEEN. LAPAROSCOPY WAS PREFORMED.
Patient noted to have significant adhesions to her anterior abdominal wall just above where we had placed our trocar with also obvious mesh with tacking. We identified her sigmoid colon which was significantly adhesed to the side wall as well as to her adnexal structures including her uterus. Tried to dissect the plane to free the colon from the both sidewalls and her uterus. Very difficult dissection and photodocumentation was preformed of this. We were able to completely mobilize the colon away from the sidewall of the adnexal structures. I went ahead and mobilized the colon up along the white line of the Toldt all the way to the splenic flexure. Once this was completed, we careflly identified in the retroperitoneum, and ureter. Did normal peristalsis. We preformed open colon resection at this point.
Patient's pneumoperitoneum was released. We made a lower midline vertical incision approximately 8 cm in length. Dissected down through fat/subcutaneous tissue. Opened fascia lengthwise then opened the peritoneum at the length of the incision. We progressively tried to bring the adhesed and diseased colon up into the wound. There was stilll significant amount of inflammation to the lateral sidewall inferiorly. We dissected this down. In the process the cautery did partially transected the ureter. We went ahead and finished our mobilization of her colon and used Echelon 60-mm stapler to transect the colon both proximally and distally using the Ace Harmonic to take down adjoining mesentery. We performed our bowel anastomosis sisde to side functional end to end anastomosis was done. Did a handsewn the common enterotomy closed as there was modest amount of tension on the anastomosis. Once this was complete hemostasis I attended the ureter. Placed a finger under the ureter which had been fairly well skeletonized during the dissection. It was very clear partial injury to it. We inject indigo carmine intravascularly and this was confirmed with blue dye indicating that the right side of the ureter was functional as well as we had indigo carmine through our structure confirming that this was the ureter. With assistance from Dr._________________we repaired this.
Once the ureter repair was complete we irrigated thoroughly and assessed for hemostatsis. Closure of wond was done and dressings were placed.
HOSPITAL CODES: 45.76, 45.94, 56.82, 54.59, 59.8
CPT CODES: I am crossing between 44130 or 45550 Sigmoid resection with primary amastomosis.
45820-45825 Primary ureteral repair
44139 Laparoscopy with splenic flexure mobilization
ANY ASSISTANCE WITH CPT CODING WOULD BE APPRECIATED. THANK YOU SO MUCH
Amy Wright
CPC-H, CCP-H, CPC, CCP, CMBS