To code for direct repair of aorta and superior mesenteric vein or not?
Patient has extensive amount of intra-abdominal fat, scarring around the pancreas and porta due to pancreatitis.
Of note, there was extensive scarring from the pancreatitis. All of the retroperitoneal nodes were adherent to the aorta. In order to carefully dissect these off, this required us to dissect the right off the surface of the aorta. There was small branch coming from the aorta to these retroperitoneal lymph nodes and due to the significant adhesions to the aorta, this resulted in some bleeding. This was controlled with finger pressure and a direct repair of the order was performed with a 5-0 Prolene suture. This achieved nice hemostasis.
We then dissected the head of the pancreas free from the lateral border of the SMV and portal vein. Due to the dense adhesions in this area, this resulted in some bleeding at the insertion of 1 of the small vein branches. This was controlled with finger pressure and a direct repair of the SMV was performed with a 5-0 Prolene suture.
The provider selected CPT 35221, which would work, but to me these would be bundled with the primary surgery code 48150.
Patient has extensive amount of intra-abdominal fat, scarring around the pancreas and porta due to pancreatitis.
Of note, there was extensive scarring from the pancreatitis. All of the retroperitoneal nodes were adherent to the aorta. In order to carefully dissect these off, this required us to dissect the right off the surface of the aorta. There was small branch coming from the aorta to these retroperitoneal lymph nodes and due to the significant adhesions to the aorta, this resulted in some bleeding. This was controlled with finger pressure and a direct repair of the order was performed with a 5-0 Prolene suture. This achieved nice hemostasis.
We then dissected the head of the pancreas free from the lateral border of the SMV and portal vein. Due to the dense adhesions in this area, this resulted in some bleeding at the insertion of 1 of the small vein branches. This was controlled with finger pressure and a direct repair of the SMV was performed with a 5-0 Prolene suture.
The provider selected CPT 35221, which would work, but to me these would be bundled with the primary surgery code 48150.