talitha82
Guest
How would I code the following? Could it be 58542 AND 58563? I can't seem to find anything saying whether or not I can code an endometrial ablation with 58542...and this description doesn't really seem to completely fit 58563?? See Below:
In the suprapubic area two fingerbreadths superior to the symphysis pubis, the skin and subcutaneous tissue was injected with 10 cc of 0.25% Marcaine with epinephrine and a transverse 10 mm incision was made, through which was passed a 10 mm sheath and trocar into the abdominal cavity under direct visualization. The trocar was removed, and a grasping forceps was then placed in through the sheath.
Exploration of the abdominal cavity was carried out. On the inferior aspect of both ovaries there was noted implants of endometriosis. The uterus was approximately 10 weeks size with multiple, firm, round areas suggestive of leiomyomata uteri. The ovaries were lifted, and exploration of the posterior cul-de-sac was carried out. On the left side was noted small implants of endometriosis along the ureter on the posterior broad ligament. On the right broad ligament there was also noted other implants of endometriosis overlying the ureter.
At this point the left round ligament was doubly clamped, cut, and electrocoagulated for 2 cm and subsequently transected, and the left broad ligament was dissected into anterior and posterior leaves. The anterior leaf was dissected down with the bladder being partially retracted down off the uterus. There was noted on the side a 1 cm implant of endometriosis. The uterine ovarian ligaments were then electrocoagulated for 2 cm and subsequently transected. Good hemostasis was obtained.
Attentions were then turned to the right side, where the right round ligament was doubly clamped, cut,and electrocoagulated for 2 cm and subsequently transected. The right broad ligament was dissected into anterior and posterior leaves and the anterior leaf being dissected down with the bladder being further retracted down off the lower uterine segment. Being that she had had most of her pain on the right, decision was made to remove her right ovary as had been previously discussed. The right infundibulopelvic ligament was identified and electrocoagulated for 2 cm using a bipolar cautery. The ligament was then transected and good hemostasis was noted. skeletonization of the uterine blood supply was performed on the right, and the vessels were
electrocoagulated using bipolar cautery. Attentions were then turned to the left side again where the anterior lip of the broad ligament was dissected down further, and the bladder was fully retracted down off the cervix. Skeletonization of the uterine blood supply was performed on the left, and the uterine vessels on the left were electrocoagulated
for 2 cm and subsequently transected. Good hemostasis was obtained.
Attentions were then turned to the right side again where the electrocoagulation was again performed of the uterine blood vessels, and they were subsequently transected. The uterus took on a dark hue, thereby indicating lack of blood flow. At this point decision was made to proceed with morcellation. The suprapubic port was removed and replaced
with a 10 mm morcellator. The right adnexa was then removed and sent to pathology for further evaluation. The uterus was then morcellized using the morcellator. There were noted multiple small fibroids throughout the uterus, the largest of which was on the anterior corpus. Morcellization was carried out until the Hulka clamp could be seen coming through the internal os. At this point, being that the cervical stump was not bleeding at all, decision was made to get rid of the endometriosis. The endometriosis on the left ovary was electrocoagulated and did not appear to be very deep. Attentions were then turned to the left broad ligament. The endometriosis on this side was tightly adherent to the ureter. Attempts were made to go retroperitoneally and to dissect the ureter off the endometriosis, but this was not possible. Electrocautery was not an option. Decision was made to leave
this implant of endometriosis. Attentions were then turned to the endometriosis on the right side, which was also overlying the ureter.
The posterior peritoneum was grasped and incised gently. Entrance into the retroperitoneal space was carried out using blunt dissection. The ureter was dissected off the implants of endometriosis, and the endometriosis overlying the ureter was excised using scissors. No electrocautery was used. Good hemostasis was obtained. The implant of endometriosis that was noted on the bladder was electrocoagulated. At this point attentions were then turned to the cervical stump. Further morcellization of the cervical stump was carried out. The Hulka clamp was removed, and the endocervical canal was cored out. Electrocautery of the remaining cervical canal was performed. Prior to the coring, the cervix was injected
with 10 cc of 1% Lidocaine with epinephrine to aid in hemostasis. After the coring, the cervical stump was then closed using interrupted 0 Vicryl sutures placed at twelve, six, and three o'clock. At this point, to aid in suspension of the cervix, sutures of 0 Vicryl were placed on the right side through the round ligament, through the peritoneum, and through the cervical stump and the cervix was elevated. On the left side another suture of 0 Vicryl was used, placed through the cervical stump through the peritoneum both posteriorly and anteriorly and the round ligament, and this was approximated to the
cervical stump. Good hemostasis was obtained. At this point the abdomen was deflated for one minute and then reinflated, and no bleeding was noted. Irrigation of the pelvis was carried out, and all remaining pieces of uterus were removed. At this point,
the CO2 gas was again allowed to escape and the instruments were removed under direct visualization. No bleeding was noted from the puncture sites. The suprapubic incision had its fascia closed using 0 Vicryl sutures. The overlying skin was closed using three 3-0 Monocryl sutures. The other three incisions were closed using Dermabond.
In the suprapubic area two fingerbreadths superior to the symphysis pubis, the skin and subcutaneous tissue was injected with 10 cc of 0.25% Marcaine with epinephrine and a transverse 10 mm incision was made, through which was passed a 10 mm sheath and trocar into the abdominal cavity under direct visualization. The trocar was removed, and a grasping forceps was then placed in through the sheath.
Exploration of the abdominal cavity was carried out. On the inferior aspect of both ovaries there was noted implants of endometriosis. The uterus was approximately 10 weeks size with multiple, firm, round areas suggestive of leiomyomata uteri. The ovaries were lifted, and exploration of the posterior cul-de-sac was carried out. On the left side was noted small implants of endometriosis along the ureter on the posterior broad ligament. On the right broad ligament there was also noted other implants of endometriosis overlying the ureter.
At this point the left round ligament was doubly clamped, cut, and electrocoagulated for 2 cm and subsequently transected, and the left broad ligament was dissected into anterior and posterior leaves. The anterior leaf was dissected down with the bladder being partially retracted down off the uterus. There was noted on the side a 1 cm implant of endometriosis. The uterine ovarian ligaments were then electrocoagulated for 2 cm and subsequently transected. Good hemostasis was obtained.
Attentions were then turned to the right side, where the right round ligament was doubly clamped, cut,and electrocoagulated for 2 cm and subsequently transected. The right broad ligament was dissected into anterior and posterior leaves and the anterior leaf being dissected down with the bladder being further retracted down off the lower uterine segment. Being that she had had most of her pain on the right, decision was made to remove her right ovary as had been previously discussed. The right infundibulopelvic ligament was identified and electrocoagulated for 2 cm using a bipolar cautery. The ligament was then transected and good hemostasis was noted. skeletonization of the uterine blood supply was performed on the right, and the vessels were
electrocoagulated using bipolar cautery. Attentions were then turned to the left side again where the anterior lip of the broad ligament was dissected down further, and the bladder was fully retracted down off the cervix. Skeletonization of the uterine blood supply was performed on the left, and the uterine vessels on the left were electrocoagulated
for 2 cm and subsequently transected. Good hemostasis was obtained.
Attentions were then turned to the right side again where the electrocoagulation was again performed of the uterine blood vessels, and they were subsequently transected. The uterus took on a dark hue, thereby indicating lack of blood flow. At this point decision was made to proceed with morcellation. The suprapubic port was removed and replaced
with a 10 mm morcellator. The right adnexa was then removed and sent to pathology for further evaluation. The uterus was then morcellized using the morcellator. There were noted multiple small fibroids throughout the uterus, the largest of which was on the anterior corpus. Morcellization was carried out until the Hulka clamp could be seen coming through the internal os. At this point, being that the cervical stump was not bleeding at all, decision was made to get rid of the endometriosis. The endometriosis on the left ovary was electrocoagulated and did not appear to be very deep. Attentions were then turned to the left broad ligament. The endometriosis on this side was tightly adherent to the ureter. Attempts were made to go retroperitoneally and to dissect the ureter off the endometriosis, but this was not possible. Electrocautery was not an option. Decision was made to leave
this implant of endometriosis. Attentions were then turned to the endometriosis on the right side, which was also overlying the ureter.
The posterior peritoneum was grasped and incised gently. Entrance into the retroperitoneal space was carried out using blunt dissection. The ureter was dissected off the implants of endometriosis, and the endometriosis overlying the ureter was excised using scissors. No electrocautery was used. Good hemostasis was obtained. The implant of endometriosis that was noted on the bladder was electrocoagulated. At this point attentions were then turned to the cervical stump. Further morcellization of the cervical stump was carried out. The Hulka clamp was removed, and the endocervical canal was cored out. Electrocautery of the remaining cervical canal was performed. Prior to the coring, the cervix was injected
with 10 cc of 1% Lidocaine with epinephrine to aid in hemostasis. After the coring, the cervical stump was then closed using interrupted 0 Vicryl sutures placed at twelve, six, and three o'clock. At this point, to aid in suspension of the cervix, sutures of 0 Vicryl were placed on the right side through the round ligament, through the peritoneum, and through the cervical stump and the cervix was elevated. On the left side another suture of 0 Vicryl was used, placed through the cervical stump through the peritoneum both posteriorly and anteriorly and the round ligament, and this was approximated to the
cervical stump. Good hemostasis was obtained. At this point the abdomen was deflated for one minute and then reinflated, and no bleeding was noted. Irrigation of the pelvis was carried out, and all remaining pieces of uterus were removed. At this point,
the CO2 gas was again allowed to escape and the instruments were removed under direct visualization. No bleeding was noted from the puncture sites. The suprapubic incision had its fascia closed using 0 Vicryl sutures. The overlying skin was closed using three 3-0 Monocryl sutures. The other three incisions were closed using Dermabond.