bevann0402@bellsouth.net
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The codes I have are 44120, 44121, 44800 and I am having trouble with a cpt code for the cecopexy. Thanks in advance for reading this. I am not sure if I have too many codes or not enough.
Thanks, Beverly
Preop diagnosis:
1. abdominal pain, six months duration with CT scan showing volvulus of small bowel
Post op diagnosis:
1. chyloperitoneum with peritonitis
2. torsion of a roux-en-y anastomosis from previous gastric resection with internal hernia, cecal volvulus and meckel's diverticulum
Operation
1. exploratory laparotomy with lysis of adhesions, take down of old roux-en-y anastomosis with redo of roux-en-y anastomosis
2. resection of meckel's diverticulum with stapled functional side to side anastomosis
3. cecopexy and gram and stain and cytology of peritoneal fluid
procedure:
the patient had a large, previous cicatrix. This was excised including the umbilical skin. this was quite deformed. this was removed and the fascia was then nicked, nicking a large amount of milky fluid came out of the abdomen. A finger was introduced in the abdominal cavity. No adhesions were noted, and this was enlarged superior/inferior fashion with electrocautery. The fluid was suctioned out for gram stain, aerobic and anaerobic, culture and sensitivity and also cytology. The incision was further enlarged. The adhesions were taken down and the bowel was delivered. there was an inflamed area with a large amount of adhesions. It appeared that the roux-en-y had a small rent in the mesentery and the bowel had herniated through this. also the patient was noted to have Meckel's diverticulum and a cecal volvulus where the cecum was up in the left upper quadrant. all areas were taken down. it appeared that the roux-en-y anastomosis had twisted on itself and was leaking lymph into the abdominal cavity. this was evaluated several different ways, irrigated out and it was elected to take down the roux-en-y anastomosisi. the limb from the ligament of treitz was measured to be approx. 36 cm plus. the limb from the stomach was noted to be quite long by twisted also.
attention was first turned to the limb coming from the stomach. area was selected proximal and distal to the previous anastomosis. this was divided utilizing GIA times two. the mesentery was taken down with the LDS stapling device. several bleeding points were noted. these were controlled with hemostats and tied with ligature of 0 vicryl. a functional, stapled side to side anastomosis was done. stay sutures were placed of 3-0 sillk. antimesenteric dog ears were taken off. Third GIA was placed across this, checked anterior and posterior prior to firing and then Allie hemostasis were used to grasp the open enterotomy and this was then closed with a TA 60. all staple lines were reinforced with 3-0 silk. the limb from the ligament of treitz, jejunum, was taken down. the excess link was taken off to avoid kinking again. this was taken down downstream from the previous anastomosis. this was then divided with a GIA and the extra mesentery was taken down with LDS stapling device. the antimesenteric edges were taken down and small enterotomy hemostats were elevated at the open enterotomy edges and a second TA 60 was used to fire across this. the anastomoses were greater than two fingerbreadths. they were side open. contents were noted coming through. also the staple lines were reinforced with 3-0 silk. no signs of kinking was noted. this was noted to lay better. the enterotomies in the mesentery were closed with 3-0 silk to avoid any further internal hernias.
attention was turned to the meckel's diverticulum. this was divided proximal/distal with a GIA. hemostats were used to take down the mesentery, and this was submitted to pathology. hemostats were tied with ligature of 0 vicryl. the antimesenteric edges were tacked down with 3-0 silk times two. antimesenteric doe ears were taken down. a third anastomosis was performed with a GIA. this was then placed and fired, checked anterior/posterior prior to firing. allis hemostasis were used to close the enterotomy and then a third TA 60 was used to fire across this. all staple lines were again reinforced with 3-0 silk and the mesentery was closed to avoid any hernias. abdominal cavity was then copiously irrigated out with warm normal saline. this was returned clear. flat 10 mm Jackson-Pratt drain was placed in the pelvis, brought out through a separate stab wound. the cecum was quite mobile, and it was elected to do a Cecopexy tacking it down to the right lower quadrant to keep it from coming out of the pelvis again. the patient had given a history of having problems with her bowels for a period of time. all areas were returned back to their anatomical position. the patient had good peristalsis, good color. no further chyle leaks were noted. the retention sutures times three placed, 1 surgilon. the wound was then closed with a single 1 prolene. the wound was irrigated out and closed with skin stapling device. retention sutures were tied over red rubber robinson catheters. drain was sutured in place with a 3-0 ethilon, placed to bulb suction. wounds were cleansed with normal saline, blotted dry, covered with adaptic, bulky bandages and taped in place.
Thanks, Beverly
Preop diagnosis:
1. abdominal pain, six months duration with CT scan showing volvulus of small bowel
Post op diagnosis:
1. chyloperitoneum with peritonitis
2. torsion of a roux-en-y anastomosis from previous gastric resection with internal hernia, cecal volvulus and meckel's diverticulum
Operation
1. exploratory laparotomy with lysis of adhesions, take down of old roux-en-y anastomosis with redo of roux-en-y anastomosis
2. resection of meckel's diverticulum with stapled functional side to side anastomosis
3. cecopexy and gram and stain and cytology of peritoneal fluid
procedure:
the patient had a large, previous cicatrix. This was excised including the umbilical skin. this was quite deformed. this was removed and the fascia was then nicked, nicking a large amount of milky fluid came out of the abdomen. A finger was introduced in the abdominal cavity. No adhesions were noted, and this was enlarged superior/inferior fashion with electrocautery. The fluid was suctioned out for gram stain, aerobic and anaerobic, culture and sensitivity and also cytology. The incision was further enlarged. The adhesions were taken down and the bowel was delivered. there was an inflamed area with a large amount of adhesions. It appeared that the roux-en-y had a small rent in the mesentery and the bowel had herniated through this. also the patient was noted to have Meckel's diverticulum and a cecal volvulus where the cecum was up in the left upper quadrant. all areas were taken down. it appeared that the roux-en-y anastomosis had twisted on itself and was leaking lymph into the abdominal cavity. this was evaluated several different ways, irrigated out and it was elected to take down the roux-en-y anastomosisi. the limb from the ligament of treitz was measured to be approx. 36 cm plus. the limb from the stomach was noted to be quite long by twisted also.
attention was first turned to the limb coming from the stomach. area was selected proximal and distal to the previous anastomosis. this was divided utilizing GIA times two. the mesentery was taken down with the LDS stapling device. several bleeding points were noted. these were controlled with hemostats and tied with ligature of 0 vicryl. a functional, stapled side to side anastomosis was done. stay sutures were placed of 3-0 sillk. antimesenteric dog ears were taken off. Third GIA was placed across this, checked anterior and posterior prior to firing and then Allie hemostasis were used to grasp the open enterotomy and this was then closed with a TA 60. all staple lines were reinforced with 3-0 silk. the limb from the ligament of treitz, jejunum, was taken down. the excess link was taken off to avoid kinking again. this was taken down downstream from the previous anastomosis. this was then divided with a GIA and the extra mesentery was taken down with LDS stapling device. the antimesenteric edges were taken down and small enterotomy hemostats were elevated at the open enterotomy edges and a second TA 60 was used to fire across this. the anastomoses were greater than two fingerbreadths. they were side open. contents were noted coming through. also the staple lines were reinforced with 3-0 silk. no signs of kinking was noted. this was noted to lay better. the enterotomies in the mesentery were closed with 3-0 silk to avoid any further internal hernias.
attention was turned to the meckel's diverticulum. this was divided proximal/distal with a GIA. hemostats were used to take down the mesentery, and this was submitted to pathology. hemostats were tied with ligature of 0 vicryl. the antimesenteric edges were tacked down with 3-0 silk times two. antimesenteric doe ears were taken down. a third anastomosis was performed with a GIA. this was then placed and fired, checked anterior/posterior prior to firing. allis hemostasis were used to close the enterotomy and then a third TA 60 was used to fire across this. all staple lines were again reinforced with 3-0 silk and the mesentery was closed to avoid any hernias. abdominal cavity was then copiously irrigated out with warm normal saline. this was returned clear. flat 10 mm Jackson-Pratt drain was placed in the pelvis, brought out through a separate stab wound. the cecum was quite mobile, and it was elected to do a Cecopexy tacking it down to the right lower quadrant to keep it from coming out of the pelvis again. the patient had given a history of having problems with her bowels for a period of time. all areas were returned back to their anatomical position. the patient had good peristalsis, good color. no further chyle leaks were noted. the retention sutures times three placed, 1 surgilon. the wound was then closed with a single 1 prolene. the wound was irrigated out and closed with skin stapling device. retention sutures were tied over red rubber robinson catheters. drain was sutured in place with a 3-0 ethilon, placed to bulb suction. wounds were cleansed with normal saline, blotted dry, covered with adaptic, bulky bandages and taped in place.
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