jdibble
True Blue
My surgeon did a laparoscopic Cholecystectomy and while in there he states he did lysis of intestinal adhesions and a drainage of fallopian collection. I have the code for the chole - 47563 and I know the lysis is bundled. However, I am not sure of the code for the fallopian tube drainage. The doctor wanted 58673 but I am sure that this is not the correct code. The only thing I can come up with is unlisted code 58679 - however I need a comparable code to give to billing for cost. If anyone has a better code that would be used or a code that I can use for pricing, it would be greatly appreciated!! 
PREOPERATIVE DIAGNOSIS: Chronic cholecystitis and cholelithiasis.
POSTOPERATIVE DIAGNOSIS: Chronic cholecystitis and cholelithiasis with adhesions of colon and small intestine and left fallopian tube collection.
OPERATION: Laparoscopic cholecystectomy and intraoperative cholangiogram with
lysis of adhesions and drainage of fallopian collection.
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: Foley catheter and orogastric tube removed postoperatively.
COMPLICATIONS: None.
FINDINGS: Thick-walled gallbladder with adhesions and a normal intraoperative cholangiogram. Adhesions in the pelvis of the sigmoid colon and what appeared to be a collection of dark old fluid in the left salpinx that was incised and drained, consistent with prior partial ectopic pregnancy surgery.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room after the induction of satisfactory general endotracheal anesthesia and a full time out.
The patient was prepped and draped in the usual sterile fashion in the supine position. A 1 cm infraumbilical incision was created in the skin and carried down via sharp dissection to the level of the fascia, which was incised with an 11 blade under direct visualization. The peritoneum was then opened and an 11 mm trocar placed in the incision. Co2 insufflation was performed as per routine.
Three additional 5 mm trocars were placed in the epigastrium, right upper quadrant and right middle quadrants under direct visualization. The gallbladder was then identified and elevated using graspers into a cephalad position. Dissection was performed until the gallbladder was completely freed down to the level of the cystic duct, which was identified and skeletonized. A single clip was placed proximally on the duct and via an Olsen cholangiogram catheter introduced into the abdomen. A cholecystoductotomy was created and the catheter introduced and controlled with a Ligaclip. Cholangiogram was performed with the above findings. The clip was then removed as was the cholangiogram catheter and the cystic duct had multiple clips applied. This was also divided. The gallbladder was removed from the bed of the liver using energy source. This was then removed from the abdominal cavity by way of the umbilical site.
Attention was then turned to the pelvis and the patient was placed in Trendelenburg. Adhesions of the large and small-intestine were taken down using a combination of the harmonic scalpel and the cold scissors. This was taken down into the pelvis in the right lower quadrant. There was a collection in what appeared to be the fallopian tube coming off of the uterus and during dissection this was incised and drained. When adhesiolysis and enterolysis was complete, the abdomen was copiously irrigated and aspirated. The trocars were removed under direct visualization, closing the 11 mm port site at the umbilicus using an 0 Maxon suture. Subcutaneous tissues were closed with 3-0 Vicryl sutures. Steri-Strips were applied to all incisions, along with sterile bandages. The patient tolerated the procedure satisfactorily and returned to recovery in stable condition. All final sponge, instrument and needle counts correct.
Thanks,
PREOPERATIVE DIAGNOSIS: Chronic cholecystitis and cholelithiasis.
POSTOPERATIVE DIAGNOSIS: Chronic cholecystitis and cholelithiasis with adhesions of colon and small intestine and left fallopian tube collection.
OPERATION: Laparoscopic cholecystectomy and intraoperative cholangiogram with
lysis of adhesions and drainage of fallopian collection.
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
DRAINS: Foley catheter and orogastric tube removed postoperatively.
COMPLICATIONS: None.
FINDINGS: Thick-walled gallbladder with adhesions and a normal intraoperative cholangiogram. Adhesions in the pelvis of the sigmoid colon and what appeared to be a collection of dark old fluid in the left salpinx that was incised and drained, consistent with prior partial ectopic pregnancy surgery.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room after the induction of satisfactory general endotracheal anesthesia and a full time out.
The patient was prepped and draped in the usual sterile fashion in the supine position. A 1 cm infraumbilical incision was created in the skin and carried down via sharp dissection to the level of the fascia, which was incised with an 11 blade under direct visualization. The peritoneum was then opened and an 11 mm trocar placed in the incision. Co2 insufflation was performed as per routine.
Three additional 5 mm trocars were placed in the epigastrium, right upper quadrant and right middle quadrants under direct visualization. The gallbladder was then identified and elevated using graspers into a cephalad position. Dissection was performed until the gallbladder was completely freed down to the level of the cystic duct, which was identified and skeletonized. A single clip was placed proximally on the duct and via an Olsen cholangiogram catheter introduced into the abdomen. A cholecystoductotomy was created and the catheter introduced and controlled with a Ligaclip. Cholangiogram was performed with the above findings. The clip was then removed as was the cholangiogram catheter and the cystic duct had multiple clips applied. This was also divided. The gallbladder was removed from the bed of the liver using energy source. This was then removed from the abdominal cavity by way of the umbilical site.
Attention was then turned to the pelvis and the patient was placed in Trendelenburg. Adhesions of the large and small-intestine were taken down using a combination of the harmonic scalpel and the cold scissors. This was taken down into the pelvis in the right lower quadrant. There was a collection in what appeared to be the fallopian tube coming off of the uterus and during dissection this was incised and drained. When adhesiolysis and enterolysis was complete, the abdomen was copiously irrigated and aspirated. The trocars were removed under direct visualization, closing the 11 mm port site at the umbilicus using an 0 Maxon suture. Subcutaneous tissues were closed with 3-0 Vicryl sutures. Steri-Strips were applied to all incisions, along with sterile bandages. The patient tolerated the procedure satisfactorily and returned to recovery in stable condition. All final sponge, instrument and needle counts correct.
Thanks,