Korbc
Expert
- Messages
- 419
- Location
- Uncasville , CT
Hey guys!
would you guys find this return to the OR after a hysterectomy to be inclusive because it was injury that was basically incidental to the procedure. this person seems to have possibly been virginal status it seems and the reason why hyst was changing gender or would you charge a 56700 or a 57200? thanks for your thoughts! i would think not 56700 because she says the hymenal ring was relatively hemostatic.
ADD-ON PROCEDURE:
Returned to the operating room on 08/19/2026. In the recovery room, the patient was noted to have more vaginal bleeding on a pad and packing than was anticipated from a routine robotic hysterectomy. Discussed possible etiologies with the patient and his mother, and the decision was made to go back to the operating room for exploration and repair of any bleeding areas. He was brought to the OR. He was given general anesthesia. He was prepped and draped in the usual sterile fashion in the dorsal lithotomy position. A speculum was placed in the vagina. The vaginal cuff was completely intact and hemostatic. The hymenal ring area was relatively hemostatic, but there was a moderate amount of clot and debris in the vagina that was evacuated with suction, and then a relatively large right vaginal sidewall laceration was noted with bleeding. Allis clamp was used to grab the apex. A 0 Vicryl was used in a locking fashion to reapproximate the vaginal mucosa as best as possible. Once that area was sutured, it was hemostatic. At that point, instruments were removed. The hymenal region was a little raw from all the manipulation and the difficulty of the caliber of the vagina, and so silver nitrate was placed along the hymenal skin tag areas that were raw and oozy. At that point, all the sites were hemostatic. The patient tolerated the procedure well. Counts were correct x2. He was taken to the recovery room in good condition.
would you guys find this return to the OR after a hysterectomy to be inclusive because it was injury that was basically incidental to the procedure. this person seems to have possibly been virginal status it seems and the reason why hyst was changing gender or would you charge a 56700 or a 57200? thanks for your thoughts! i would think not 56700 because she says the hymenal ring was relatively hemostatic.
ADD-ON PROCEDURE:
Returned to the operating room on 08/19/2026. In the recovery room, the patient was noted to have more vaginal bleeding on a pad and packing than was anticipated from a routine robotic hysterectomy. Discussed possible etiologies with the patient and his mother, and the decision was made to go back to the operating room for exploration and repair of any bleeding areas. He was brought to the OR. He was given general anesthesia. He was prepped and draped in the usual sterile fashion in the dorsal lithotomy position. A speculum was placed in the vagina. The vaginal cuff was completely intact and hemostatic. The hymenal ring area was relatively hemostatic, but there was a moderate amount of clot and debris in the vagina that was evacuated with suction, and then a relatively large right vaginal sidewall laceration was noted with bleeding. Allis clamp was used to grab the apex. A 0 Vicryl was used in a locking fashion to reapproximate the vaginal mucosa as best as possible. Once that area was sutured, it was hemostatic. At that point, instruments were removed. The hymenal region was a little raw from all the manipulation and the difficulty of the caliber of the vagina, and so silver nitrate was placed along the hymenal skin tag areas that were raw and oozy. At that point, all the sites were hemostatic. The patient tolerated the procedure well. Counts were correct x2. He was taken to the recovery room in good condition.