ksrkelly7
Networker
My doc wants to bill the following codes for this OP report.
49321 49565 49568
I think the codes should be 47939 (unlisted laps liver procedure) and 49585.
My other issue is the laps then open. I don't believe I can even bill for the liver biopsy 47939 if we are billing the hernia repair. Any help on this would be great.
Indication for Surgery
Umbilical bulge and pain, focal nodular hyperplasia of the liver
Preoperative Diagnosis
Focal nodular hyperplasia of the liver, recurrent umbilical hernia, diastasis recti
Postoperative Diagnosis
Same
Operation
Diagnostic laparoscopy with excisional biopsy of the liver nodule, repair of the recurrent umbilical hernia and diastasis recti with mesh implantation
Findings
There was an approximately 1.5 cm fascial defect at the umbilicus. Pre-peritoneal fat was protruding through the defect. There was a 5-6 mm nodule of the anterior left lobe of the liver. The diastasis was approximately 3 cm in distance between the medial edges of the rectus muscles.
Specimen(s)
Liver nodule
Complications
None
Technique
After pre-operative evaluation and informed consent was obtained, the patient was brought to the operating room. She was placed under suitable general anesthesia with endotracheal intubation. Sequential compression devices were applied. IV antibiotics were administered. A surgical pause was performed to confirm the patient identification and correct surgical procedure. The patient was then prepared and 3 minutes of drying time for the prep was allowed prior to draping the patient in the usual sterile fashion.
The anticipated skin incision site was marked with a marking pen and the tissues surrounding this were infiltrated with 0.5% Marcaine with epinephrine. The skin incision was made and carried down through the subcutaneous tissues to the hernia sac. The hernia sac was dissected away from the subcutaneous tissues and the overlying umbilicus. The dissection was carried down to the fascial defect. A 10 mm non-bladed port was placed through the fascial opening into the abdominal cavity without complication. The abdomen was insufflated with CO2 to a pressure of 15 mm Hg. A 30 degree videolaparoscope was inserted and the abdomen was examined. The liver had fatty infiltration, but there was a nodule in the anterior left lobe of the liver. Additional 5 mm ports were placed in the epigastrium and left upper quadrant. The nodule was excised using sharp dissection. Hemostasis of the biopsy site was obtained using the electrocautery device. There was excellent hemostasis. The abdomen was desufflated after the ports were removed. There was no bleeding from these sites. The linea alba and anterior rectus sheath in the epigastric area were exposed using the electrocautery device. This was carried to just below the xiphoid. The umbilical fascial defect was closed using 0-Prolene suture in an interrupted fashion. The rectus sheath was then imbricated from below the umbilical fascial defect to the sub-xiphoid area, to approximate the medial edges of the rectus muscles. This was performed using #1 Prolene suture. A 3 x 6 inch sheet of Prolene mesh was brought onto the field. This was cut to appropriate size and sutured to the anterior abdominal wall using 0-Prolene interrupted suture circumferentially. The wound was copiously irrigated with saline solution. There continued to be excellent hemostasis. The subcutaneous tissues were approximated with 3-0 Vicryl suture. The skin was closed using 4-0 Monocryl suture. Dermabond was applied as well as a Coverderm dressing. The patient was awakened out of anesthesia, extubated and transported to the recovery room in stable condition.
Thanks,
Kelly CPC-A
49321 49565 49568
I think the codes should be 47939 (unlisted laps liver procedure) and 49585.
My other issue is the laps then open. I don't believe I can even bill for the liver biopsy 47939 if we are billing the hernia repair. Any help on this would be great.
Indication for Surgery
Umbilical bulge and pain, focal nodular hyperplasia of the liver
Preoperative Diagnosis
Focal nodular hyperplasia of the liver, recurrent umbilical hernia, diastasis recti
Postoperative Diagnosis
Same
Operation
Diagnostic laparoscopy with excisional biopsy of the liver nodule, repair of the recurrent umbilical hernia and diastasis recti with mesh implantation
Findings
There was an approximately 1.5 cm fascial defect at the umbilicus. Pre-peritoneal fat was protruding through the defect. There was a 5-6 mm nodule of the anterior left lobe of the liver. The diastasis was approximately 3 cm in distance between the medial edges of the rectus muscles.
Specimen(s)
Liver nodule
Complications
None
Technique
After pre-operative evaluation and informed consent was obtained, the patient was brought to the operating room. She was placed under suitable general anesthesia with endotracheal intubation. Sequential compression devices were applied. IV antibiotics were administered. A surgical pause was performed to confirm the patient identification and correct surgical procedure. The patient was then prepared and 3 minutes of drying time for the prep was allowed prior to draping the patient in the usual sterile fashion.
The anticipated skin incision site was marked with a marking pen and the tissues surrounding this were infiltrated with 0.5% Marcaine with epinephrine. The skin incision was made and carried down through the subcutaneous tissues to the hernia sac. The hernia sac was dissected away from the subcutaneous tissues and the overlying umbilicus. The dissection was carried down to the fascial defect. A 10 mm non-bladed port was placed through the fascial opening into the abdominal cavity without complication. The abdomen was insufflated with CO2 to a pressure of 15 mm Hg. A 30 degree videolaparoscope was inserted and the abdomen was examined. The liver had fatty infiltration, but there was a nodule in the anterior left lobe of the liver. Additional 5 mm ports were placed in the epigastrium and left upper quadrant. The nodule was excised using sharp dissection. Hemostasis of the biopsy site was obtained using the electrocautery device. There was excellent hemostasis. The abdomen was desufflated after the ports were removed. There was no bleeding from these sites. The linea alba and anterior rectus sheath in the epigastric area were exposed using the electrocautery device. This was carried to just below the xiphoid. The umbilical fascial defect was closed using 0-Prolene suture in an interrupted fashion. The rectus sheath was then imbricated from below the umbilical fascial defect to the sub-xiphoid area, to approximate the medial edges of the rectus muscles. This was performed using #1 Prolene suture. A 3 x 6 inch sheet of Prolene mesh was brought onto the field. This was cut to appropriate size and sutured to the anterior abdominal wall using 0-Prolene interrupted suture circumferentially. The wound was copiously irrigated with saline solution. There continued to be excellent hemostasis. The subcutaneous tissues were approximated with 3-0 Vicryl suture. The skin was closed using 4-0 Monocryl suture. Dermabond was applied as well as a Coverderm dressing. The patient was awakened out of anesthesia, extubated and transported to the recovery room in stable condition.
Thanks,
Kelly CPC-A