hsmith67
Guru
Any suggestions on how to code this is greatly appreciated!
Summary - Diagnostic laparoscopy, right lobe of liver biopsy of a tumor (laparoscopic), converted to open laparotomy with partial hepatectomy (segment 6).
After informed consent.....Following placement of all trocars, the laparoscope and grasping forceps was introduced into the abdomen and diagnostic laparoscopy was performed. The liver was noted to be enlarged secondary to fatty infiltration and soft to the touch. The gallbladder was normal. No masses were seen in the left and caudate lobe of the liver. An atraumatic grasper was used to elevate the liver wedge. On the lateral aspect of the right lobe of the liver, there was a golf ball sized tumor in segment 6. It appeared to have gelatin like consistency and very vascular. The grasping forceps were used to remove several pieces from the tumor. The specimens were sent for frozen section. The pathologist reported the specimen to be consistent with isolated cirrhotic tissue. No malignancy identified, final pathology pending. At this point, we decided that since the tumor appeared malignant and was located in an area that can be resected I decided to convert to an open laparotomy with resection with partial hepatectomy of segment 6. The abdomen was opened through...The peritoneum was entered and the abdominal cavity was inspected. Palpation of the liver revealed no additional lesion palpated on the surface of the right lobe and left lobe of the liver. On the lateral aspect of the right lobe, segment 6, there was a golf ball size tumor that was visibly present. The Bookwalter retracting system was used to provide adequate exposure for surgery. The planned margin of resection was estimated by palpation and the liver capsule was scored using cautery to outline a 5 cm margin from the lesion. The parenchyma was compressed with liver sutures placed on either side of the scored parenchyma. Using 0 chromic in liver needle, the liver parenchyma was doubly tied and divided with electrocautery between the 2 suture lines. This was continue in piecemeal fashion, obtaining hemostasis during the process of the dissection. The lobe of the liver was also divided using a fracture fragmentation clamping and suture ligation. Once the specimen was removed and passed off the table, it was sent for pathology. Hemostasis was achieved using suture ligatures to compress the edge of the resected liver for hemostasis. The gallbladder was left in place and not removed during the process. The surgical site was hemostatic and the end of dissection. ...
Again, thanks for any help on this case!
Hunter Smith, CPC
Summary - Diagnostic laparoscopy, right lobe of liver biopsy of a tumor (laparoscopic), converted to open laparotomy with partial hepatectomy (segment 6).
After informed consent.....Following placement of all trocars, the laparoscope and grasping forceps was introduced into the abdomen and diagnostic laparoscopy was performed. The liver was noted to be enlarged secondary to fatty infiltration and soft to the touch. The gallbladder was normal. No masses were seen in the left and caudate lobe of the liver. An atraumatic grasper was used to elevate the liver wedge. On the lateral aspect of the right lobe of the liver, there was a golf ball sized tumor in segment 6. It appeared to have gelatin like consistency and very vascular. The grasping forceps were used to remove several pieces from the tumor. The specimens were sent for frozen section. The pathologist reported the specimen to be consistent with isolated cirrhotic tissue. No malignancy identified, final pathology pending. At this point, we decided that since the tumor appeared malignant and was located in an area that can be resected I decided to convert to an open laparotomy with resection with partial hepatectomy of segment 6. The abdomen was opened through...The peritoneum was entered and the abdominal cavity was inspected. Palpation of the liver revealed no additional lesion palpated on the surface of the right lobe and left lobe of the liver. On the lateral aspect of the right lobe, segment 6, there was a golf ball size tumor that was visibly present. The Bookwalter retracting system was used to provide adequate exposure for surgery. The planned margin of resection was estimated by palpation and the liver capsule was scored using cautery to outline a 5 cm margin from the lesion. The parenchyma was compressed with liver sutures placed on either side of the scored parenchyma. Using 0 chromic in liver needle, the liver parenchyma was doubly tied and divided with electrocautery between the 2 suture lines. This was continue in piecemeal fashion, obtaining hemostasis during the process of the dissection. The lobe of the liver was also divided using a fracture fragmentation clamping and suture ligation. Once the specimen was removed and passed off the table, it was sent for pathology. Hemostasis was achieved using suture ligatures to compress the edge of the resected liver for hemostasis. The gallbladder was left in place and not removed during the process. The surgical site was hemostatic and the end of dissection. ...
Again, thanks for any help on this case!
Hunter Smith, CPC