Lap Volvulus vs appy

nlbarnes

Guru
Messages
188
Location
Escondido, CA
Best answers
0
Hello - would you code this 44970 or 44238?

PROCEDURES PERFORMED:
1. Laparoscopic lysis of adhesions.
2. Laparoscopic appendectomy.
3. Laparoscopic closure of potential internal hernia site.

SPECIMEN:
Appendix.


OPREATIVE FINDINGS:
Some minor adhesions throughout the abdomen and some chronic kinking
at the little bit distal to the anastomosis, but no significant
ischemic bowel obstruction at all. We did a very small amount of
lysis of adhesions to loosen up the bowel. He had a normal appendix
as well as the potential internal hernia site with no actual internal
hernia.

DESCRIPTION OF PROCEDURE:
We began by running the small bowel
from the ligament of Treitz, down to the ileocecal valve. All of the
small bowel was very free and there were couple of adhesions that we
needed to lyse in order to loosen up the small bowel. There was some
tethering little bit at the distal to the jejunojejunostomy, but this
was easily loosened up and the bowel straightened out after that.
This essentially released the small bowel obstruction, which was a
little bit distal to the anastomosis. The remainder of the small
bowel was very free and very easy to mobilize. We did identify the
appendix of the right lower quadrant. We decided to remove that. We
made a window at the base of the appendix and cecum level, fired an
Echelon Ethicon blue load stapler across the base of the appendix and
a white load stapler across the mesoappendix. The mesoappendix was
reinforced with Harmonic Scalpel for hemostasis. The appendix was
placed in an Endobag and removed through the 12 mm trocar site. We
then looked back at our cavity. We inspected the jejunojejunostomy,
but there was a potential internal hernia site with no actual internal
hernia. We closed this with three interrupted 2-0 silk sutures
without any problem. We did run the small bowel again from the
ileocecal valve to the ligament of Treitz
 

cgaston

Expert
Messages
494
Location
Clarence, NY
Best answers
0
There is no indication for the appendectomy if the appendix was healthy so I don't think that would be authorized....unless the pathology showed something?

I would go with 44180 for the release of the small bowel obstruction, since the lysis of adhesions freed up the small bowel.
 
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