LScoder2016
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Im newer to general surgery. The CPT codes I got were 44970 and 58662. There is an NCCI edit between the two.
I found this add on code, 44955- Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure)
But thats an open procedure in the description.
Any insight would be greatly appreciated.
Preoperative Diagnosis: Abdominal pain and right pelvic cyst
Postoperative Diagnosis: Right pelvic cyst and appendiceal cystic nodule
Procedure(s) Performed: Exploratory laparoscopy with Laparoscopic appendectomy and resection of right pelvic cyst
Specimen(s) Obtained/Removed: Appendix with peri appendiceal lymph node and right pelvic cyst
Findings: The patient's appendix in the proximal midportion appeared completely normal. At the very tip of the appendix it seemed somewhat bulbous and there appeared to be a cystic nodule involving the tip of the appendix. There was a large cyst adjacent to the cecum in the pelvis which I was able to excise in its entirety without spillage of the cyst contents. To remove it from the Endo-Catch bag I did have to rupture it and aspirate the contents. The patient also had a fairly large left ovarian cyst. Photographs were obtained of the findings.
Operative Technique: The abdomen was prepped and draped in aseptic manner. Timeout was performed. I then placed a 5 mm trocar through a small transverse incision in the right upper quadrant and then advanced the trocar through the abdominal wall under direct visualization with the scope inserted through the trocar. Once in the peritoneal cavity pneumoperitoneum was created. I then placed another 5 mm port in the suprapubic region just to the left of the midline through another small transverse incision. I switched the camera to the suprapubic port and then placed a 12 mm trocar through a small transverse incision just above the umbilicus I then placed the patient in Trendelenburg position with the left side down and used a padded grasper to grasp the cecum and lifted up, exposing the appendix. I then grasped the appendix and lifted it up and used the Harmonic scalpel to divide the mesoappendix. Once the mesoappendix was divided I used the echelon stapler with a blue load to transect the appendix at its base. There was excellent hemostasis. There was a prominent lymph node in the mesentery at the base of the appendix that I removed using the harmonic scalpel. This also was removed using the laparoscopic stone forceps. I then mobilized the cyst in the pelvis which was attached to the surrounding structures only with some flimsy attachments. The attachments were divided using harmonic scalpel. I then placed the cyst and the appendix into an Endo Catch bag and brought the Endo-Catch bag up into the umbilical incision. I opened the bag and removed the appendix 1st using a sponge stick. It was removed intact. I then used the sponge stick to rupture the cyst in the Endo-Catch bag and aspirated its contents with the suction irrigator. I then removed the bag and cyst through the 12 mm port. The 12 mm port was then replaced and the right lower quadrant irrigated out with antibiotic irrigation. There was no bleeding evident. I then inspected the rest of the abdomen and obtained photos of the uterus, adnexa, and ovaries. I then removed the 12 mm port and used the Endo Close apparatus with an 0 Vicry
I found this add on code, 44955- Appendectomy; when done for indicated purpose at time of other major procedure (not as separate procedure) (List separately in addition to code for primary procedure)
But thats an open procedure in the description.
Any insight would be greatly appreciated.
Preoperative Diagnosis: Abdominal pain and right pelvic cyst
Postoperative Diagnosis: Right pelvic cyst and appendiceal cystic nodule
Procedure(s) Performed: Exploratory laparoscopy with Laparoscopic appendectomy and resection of right pelvic cyst
Specimen(s) Obtained/Removed: Appendix with peri appendiceal lymph node and right pelvic cyst
Findings: The patient's appendix in the proximal midportion appeared completely normal. At the very tip of the appendix it seemed somewhat bulbous and there appeared to be a cystic nodule involving the tip of the appendix. There was a large cyst adjacent to the cecum in the pelvis which I was able to excise in its entirety without spillage of the cyst contents. To remove it from the Endo-Catch bag I did have to rupture it and aspirate the contents. The patient also had a fairly large left ovarian cyst. Photographs were obtained of the findings.
Operative Technique: The abdomen was prepped and draped in aseptic manner. Timeout was performed. I then placed a 5 mm trocar through a small transverse incision in the right upper quadrant and then advanced the trocar through the abdominal wall under direct visualization with the scope inserted through the trocar. Once in the peritoneal cavity pneumoperitoneum was created. I then placed another 5 mm port in the suprapubic region just to the left of the midline through another small transverse incision. I switched the camera to the suprapubic port and then placed a 12 mm trocar through a small transverse incision just above the umbilicus I then placed the patient in Trendelenburg position with the left side down and used a padded grasper to grasp the cecum and lifted up, exposing the appendix. I then grasped the appendix and lifted it up and used the Harmonic scalpel to divide the mesoappendix. Once the mesoappendix was divided I used the echelon stapler with a blue load to transect the appendix at its base. There was excellent hemostasis. There was a prominent lymph node in the mesentery at the base of the appendix that I removed using the harmonic scalpel. This also was removed using the laparoscopic stone forceps. I then mobilized the cyst in the pelvis which was attached to the surrounding structures only with some flimsy attachments. The attachments were divided using harmonic scalpel. I then placed the cyst and the appendix into an Endo Catch bag and brought the Endo-Catch bag up into the umbilical incision. I opened the bag and removed the appendix 1st using a sponge stick. It was removed intact. I then used the sponge stick to rupture the cyst in the Endo-Catch bag and aspirated its contents with the suction irrigator. I then removed the bag and cyst through the 12 mm port. The 12 mm port was then replaced and the right lower quadrant irrigated out with antibiotic irrigation. There was no bleeding evident. I then inspected the rest of the abdomen and obtained photos of the uterus, adnexa, and ovaries. I then removed the 12 mm port and used the Endo Close apparatus with an 0 Vicry