donna3679
Contributor
I have attached a surgical op note that I need help coding, major of surgery was performed by the OBGYN dr., my doctor is second portion. What my doctor did looks like its a 15777, but that is an add on code. Please help me!!! Do I code surgery what OBGYN did with 62 mod so I can bill mesh placement.
OBGYN OP note: * MASS EXCISION / ABDOMINAL WALL, SALPINGO OOPHORECTOMY OPEN left oophorectomy, left iliac node dissection, abdominal wall mass dissection, with mesh placement.
The fat was dissected down to the fascia. The rectus muscles were transected using the Bovie and isolating tied off the inferior epigastric vessel. The entire lower abdominal wall was then excised including the peritoneum which had tumor growing through it below the mass down to the pubic bone and the mass was dissected off the pubic bone. There was no significant blood loss at this time. The pubic bone had gross tumor invading in the anterior aspect of the periosteum this was cut with a knife and sent for frozen documenting invasion at this point.
The left ovary and tube were identified were completely normal. After the pelvis was isolated grasped transected and ligated and the left tube and ovary were excised and passed off table the left retroperitoneal space was opened revealing an 8 cm iliac lymph node that was involving the iliac vein and artery as well as the ureter and the obliterated umbilical artery using a right angle retractor this was dissected off the vein and artery and removed intact and passed off table completely excising this large metastatic lymph node. 1 further lymph node was found in fat above the inguinal ligament and this was excised. The pelvis was then irrigated and family hemostatic at completion of this point the left ureter iliac vessels and nerves were to accurately completely dissect down the left pelvic sidewall with no residual tumor being present.
** My Doctor: This portion of the operative note will address the abdominal wall reconstruction. Excision of the abdominal wall tumor and lymph node dissection will be dictated by Dr. OBGYN .
Electric tumor and lymph nodes were resected and the abdominal wall was reconstructed using a piece of Stratus biologic mesh this was first sutured to the pubic bone after drilling for holes in the anterior and posterior surface of the apex of the pubic bone 0 Ethibond sutures were utilized to attach their Stratus in interrupted mattress fashion the Stratus was attached to the surrounding abdominal wall fascia circumferentially using interrupted 0 Ethibond sutures once in place the sutures were tied there was really good reconstruction to the abdominal wall. Drains were placed over the surface of the Stratus and the subcutaneous tissues were closed with 0 Vicryl skin was closed with 3-0 and 2-0 nylon. The patient tolerated the procedure well without complications.
OBGYN OP note: * MASS EXCISION / ABDOMINAL WALL, SALPINGO OOPHORECTOMY OPEN left oophorectomy, left iliac node dissection, abdominal wall mass dissection, with mesh placement.
The fat was dissected down to the fascia. The rectus muscles were transected using the Bovie and isolating tied off the inferior epigastric vessel. The entire lower abdominal wall was then excised including the peritoneum which had tumor growing through it below the mass down to the pubic bone and the mass was dissected off the pubic bone. There was no significant blood loss at this time. The pubic bone had gross tumor invading in the anterior aspect of the periosteum this was cut with a knife and sent for frozen documenting invasion at this point.
The left ovary and tube were identified were completely normal. After the pelvis was isolated grasped transected and ligated and the left tube and ovary were excised and passed off table the left retroperitoneal space was opened revealing an 8 cm iliac lymph node that was involving the iliac vein and artery as well as the ureter and the obliterated umbilical artery using a right angle retractor this was dissected off the vein and artery and removed intact and passed off table completely excising this large metastatic lymph node. 1 further lymph node was found in fat above the inguinal ligament and this was excised. The pelvis was then irrigated and family hemostatic at completion of this point the left ureter iliac vessels and nerves were to accurately completely dissect down the left pelvic sidewall with no residual tumor being present.
** My Doctor: This portion of the operative note will address the abdominal wall reconstruction. Excision of the abdominal wall tumor and lymph node dissection will be dictated by Dr. OBGYN .
Electric tumor and lymph nodes were resected and the abdominal wall was reconstructed using a piece of Stratus biologic mesh this was first sutured to the pubic bone after drilling for holes in the anterior and posterior surface of the apex of the pubic bone 0 Ethibond sutures were utilized to attach their Stratus in interrupted mattress fashion the Stratus was attached to the surrounding abdominal wall fascia circumferentially using interrupted 0 Ethibond sutures once in place the sutures were tied there was really good reconstruction to the abdominal wall. Drains were placed over the surface of the Stratus and the subcutaneous tissues were closed with 0 Vicryl skin was closed with 3-0 and 2-0 nylon. The patient tolerated the procedure well without complications.