Intraop consult resulting in suture of sigmoid?

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I have been struggling with this one, and I am finally coming here for help.

The patient is a xx-year-old female presently having an open laparotomy for bilateral tuboovarian abscesses. Five days ago, she had an open appy for acute appendicitis. Five days prior to that, she had a vaginal hysty for benign reasons. At the time of laparotomy today, Dr. xxxx was concerned about a serosal tear in the sigmoid. I was asked to do intraoperative consult.

The tear was actually in the sigmoid loop. It was only partial thickness involving seromuscular layers. This was simply closed with several interrupted sutures of 3-0 chromic. It did not appear to be a part of the abscess.

In the sigmoid mesentery, there was evidence of abscess wall hemorrhage, friability, and some early granulation which had been disrupted during the dissection for the pelvic abscess. There did not appear to be any direct bowel injury at this level. No suturing was required.

The cecum was inspected and found to show evidence of recent appy but no evidence of reaction around the appendiceal stump. In fact, the appendiceal stump had been buried with chromic suture at the time of initial operation. There was a small defect in the mesentery at the base of the cecum, apparently secondary to the dissection a week ago. This was buried with a 3-0 chromic mattress suture today. There was no evidence of GI leakage during this dissection. The procedure was turned back to Dr. xxxx.

My doc did the appy but not the vag hysty. We are obviously in a global period for both procedures, but do I only code the intraop consult? Only the sigmoid suture (which I have no idea how to do)? Or what??

Thanks for your help!


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I would bill code 44604 for the sigmoid suture and add modifier 79. I would not bill the consult in this case.