MelWolfe
New
I need some help we picked CPT code 47490, but the provider is questioning the CPT code since it was a time consuming case and wanted to know if there was anything different that could be coded. Would we also code the Lap Cholecystectomy with the modifer 53 discontinued procedure. I need to know how you would code this surgery.
This is the OR report
Preoperative Diagnosis: Acute Cholecystitis with cholelithiasis
PostOperative Diagnosis: Acute and chronic cholecystitis with cholelithiasis
Procedure: Laparoscopic Cholecystostomy Tube Placement
Anesthesia: General
Indication and Findings:
This is a 60 year old woman who presented with significant problems due to acute cholecystitis. Surgery was recommended. Indications for the procedure, alternative, risks, and potential complications were discussed with the patient and she asked the procedure to be done. During the procedure, she did have an acutely inflamed gallbladder. The dissection was begun. It was adherent to a lot of surrounding tissues, but this could not be completed because of the significant oozing of blood and because her platelet counts are so low it was felt that she should just have a cholcystostomy tube placed and wait to remove the gallbladder another day. Therefore, I did a cholecystostomy tube, which she tolerated the procedure well without complications.
Technique:
The patient was brought to the operating room, given anesthesia, prepped and draped in sterile fashion. An infraumbilical incision was made and a Veress needle inserted into the abdomen and the pneumoperitoneum was created. A 10mm port was placed under direct visualization. Another 10mm port was placed subxiphoid to the right of the midline under direct visualization. Two 5mm ports were placed in the right upper quadrant under direct visualization. There were adherent tissues to the inflamed gallbaldder. The gallbladder count not be grasped with an instrument without piercing it, so it was piercing it, so it was pierced and some mid gallbladder material with small stones came out and were aspirated out. All spillage was irrigated and aspirated as well. The body was able to be grasped and retracted anteriorly and superiorly. The infundibulum was able to be dissected free and in the course of dissection, there was oozing from all of the tissues and because of her platelet count, I decided to not and after looking at the area of the cystic duct and cystic artery that area was too dangerous to be dissected so I decided on a cholecystostomy tube through one of the port holes on the right upper quadrant. A Malecot drain was placed percutaneously into the hole that was already made in the gallbladder. Just to secure this very floppy gallbladder into position an Ethibond suture was used to attache it to the anterior abdominal wall so that it would maintain its position because of the length of the gallbladder and because it was so large and floppy. This was found to be in good position. The drain was sutured to the skinwith nylon sutre. A Jackson-Pratt drain was placed into Morrision's pouch and brought out through the other port hole and sutured to the skin with nylon suture. The abdomen was irrigated to remove excess blood and hemostasis and hemostasis was found to be good. Ports were removed. Pneumoperitoneum was released and the other skin incisions were closed with Moncryl subcuticular stitches. Sterile dressings were applied. The patient was extubated and transported to recovery in satisfactory condition.
Thank you,
Melinda
This is the OR report
Preoperative Diagnosis: Acute Cholecystitis with cholelithiasis
PostOperative Diagnosis: Acute and chronic cholecystitis with cholelithiasis
Procedure: Laparoscopic Cholecystostomy Tube Placement
Anesthesia: General
Indication and Findings:
This is a 60 year old woman who presented with significant problems due to acute cholecystitis. Surgery was recommended. Indications for the procedure, alternative, risks, and potential complications were discussed with the patient and she asked the procedure to be done. During the procedure, she did have an acutely inflamed gallbladder. The dissection was begun. It was adherent to a lot of surrounding tissues, but this could not be completed because of the significant oozing of blood and because her platelet counts are so low it was felt that she should just have a cholcystostomy tube placed and wait to remove the gallbladder another day. Therefore, I did a cholecystostomy tube, which she tolerated the procedure well without complications.
Technique:
The patient was brought to the operating room, given anesthesia, prepped and draped in sterile fashion. An infraumbilical incision was made and a Veress needle inserted into the abdomen and the pneumoperitoneum was created. A 10mm port was placed under direct visualization. Another 10mm port was placed subxiphoid to the right of the midline under direct visualization. Two 5mm ports were placed in the right upper quadrant under direct visualization. There were adherent tissues to the inflamed gallbaldder. The gallbladder count not be grasped with an instrument without piercing it, so it was piercing it, so it was pierced and some mid gallbladder material with small stones came out and were aspirated out. All spillage was irrigated and aspirated as well. The body was able to be grasped and retracted anteriorly and superiorly. The infundibulum was able to be dissected free and in the course of dissection, there was oozing from all of the tissues and because of her platelet count, I decided to not and after looking at the area of the cystic duct and cystic artery that area was too dangerous to be dissected so I decided on a cholecystostomy tube through one of the port holes on the right upper quadrant. A Malecot drain was placed percutaneously into the hole that was already made in the gallbladder. Just to secure this very floppy gallbladder into position an Ethibond suture was used to attache it to the anterior abdominal wall so that it would maintain its position because of the length of the gallbladder and because it was so large and floppy. This was found to be in good position. The drain was sutured to the skinwith nylon sutre. A Jackson-Pratt drain was placed into Morrision's pouch and brought out through the other port hole and sutured to the skin with nylon suture. The abdomen was irrigated to remove excess blood and hemostasis and hemostasis was found to be good. Ports were removed. Pneumoperitoneum was released and the other skin incisions were closed with Moncryl subcuticular stitches. Sterile dressings were applied. The patient was extubated and transported to recovery in satisfactory condition.
Thank you,
Melinda