Wiki Laparoscopic Closure of Peritoneum Post Hernia Surgery

knstrauch

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Please help resolve a dispute. One coder believe that this should be billed 44620 another 49329. Any input would be appreciated.

OPERATION PERFORMED:

1. Diagnostic laparoscopy.
2. Reduction of internal hernia.
3. Closure of peritoneum.


PREOPERATIVE DIAGNOSIS: Small bowel obstruction.
POSTOPERATIVE DIAGNOSIS: Small bowel obstruction.

DESCRIPTION OF PROCEDURE: We used the same infraumbilical 5 mm incision and
reopened the incision. Due to his recent surgery, we used the same opening to
enter a 5 mm port with a blunt tip. Once the port was entered, insufflation was
obtained. Two additional ports were placed initially 5 mm on the left and right
side of the umbilical port. On initial evaluation, the patient had a loop of
small bowel going into the peritoneum, which appeared to be herniated through
the peritoneal defect, even though it appeared that the peritoneum had split
open. Using 2 blunt graspers, we were able to reduce the small bowel out of
this defect and evaluate the small bowel which appeared viable and pink. The
small defect which measured roughly 1 cm was closed with intracorporeal suture
using 3-0 Vicryl suture, using a figure-of-eight suture. In order to do that,
we did have to insert a 12 mm port on the left side. Next, we evaluated for any
other defect and we did not find any other issues, so at this time desufflation
was achieved and the fascia of the 12 mm was closed with interrupted
figure-of-eight Vicryl suture. The skin of all the incision was closed with 4-0
suture. Local was injected. Sterile dressings and Dermabond were placed over
the skin incisions. All sponge, needle and instrument counts were correct at
the end of the procedure.
 
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