jdibble
True Blue
My OB performed the following surgery and is asking what CPT codes would be appropriate. I am having trouble finding codes - I believe I would use 59899-78 for the Barki Balloon, however I am not sure which codes to use for the repairs. Please anyone who can help - he wants an answer fast! 
DESCRIPTION OF PROCEDURE: The patient was taken to the OR and placed in
dorsal lithotomy position, prepped abdominally and vaginally. The fundus was
massaged with expression of approximately 200 mL of clot. The vagina and
cervix was inspected. There was no evidence of cervical or vaginal
lacerations. The patient was placed in low lithotomy position, draped in
sterile manner. Staples removed. The incision was opened. The fascia was
opened. There was no unusual blood accumulation in the abdomen. The uterus
was boggy despite massage and intrauterine Hemabate. The uterine incision was
intact and dry. Uterus was elevated out of the abdomen. The uterine vessels
were identified by palpation and then sutured with a single stitch of #1
chromic at the level of the internal cervical os. The infundibulopelvic
ligaments were similarly sutured with a single throw of #1 chromic suture.
Several B Lynch sutures were placed and tightened while compressing the
uterus. The uterus was boggy and bulging and the bulging areas were sutured
down as well. The patient was then again examined vaginally. The uterine
cavity could be evaluated. There was no retained tissue or clots. This had
been done several times prior to surgery. A Bakri balloon was placed into the
uterus and filled initially with 300 mL of fluid. The patient still
experienced bleeding and was filled ultimately to 500 mL. The patient had no
bleeding from the drainage tube with the Bakri balloon, rather the bleeding
continued around the balloon from the cervix and lower uterine segment.
Careful inspection for bleeders. The cervix was grasped with ring forceps in
several places and sutured without improvement of the bleeding. The vagina
was tightly packed against the balloon. Initially, there was good hemostasis.
The abdomen was again inspected. The uterus, tubes and ovaries were
inspected. The ovaries appeared healthy. There is no oozing or unusual fluid
collection. The muscle subfascial area was dried. The fascia was closed with
0 PDS continuous running suture in 2 lengths. Subcutaneous layer was
approximated with 2-0 plain suture. Skin was closed with staples. At this
point, the patient was again examined and noted that the vaginal packing had
bled through. The vaginal packing was removed and was rung out with
approximately 50 mL of thin bloody fluid. Packing was repeated using lap
pads. The husband was notified of the difficult situation and possible need
for hysterectomy. The abdomen was again opened. Since the bleeding seemed to
be mostly from the lower uterine segment and cervix, the bladder was advanced
off the cervix and the cervix was closed front to back with #1 chromic
sutures. This provided good hemostasis although there was oozing from the
cervix. The vagina was again tightly packed 1st with just 1 packing. It was
observed for 5-10 minutes, was virtually dry and the rest of the vagina was
then packed tying all the lengths of gauze together. The abdomen was again
inspected. There was noted to be oozing from the uterus at the uterine
incisions and the uterine vessels which were secured. Again, the ovaries were
inspected and both looked healthy. Good hemostasis was obtained. The fascia
was closed with 0 PDS continuous running suture in 2 lengths. Subcutaneous
layer was irrigated, and skin was closed with staples. Pressure dressing
applied. The vagina was again inspected. The upper part of the packing was
damp, but not soaked. At the introitus, there was bleeding from
instrumentation and exams. These oozing areas were controlled with cautery
and 3-0 Vicryl suture as needed. The patient was oozing minimally at the end
of the procedure. It was felt that her blood loss could be kept up with and
the procedure without complication. Counts were correct. Estimated blood
loss during the procedure was 500 mL.
Thanks for all of the help I can get!
DESCRIPTION OF PROCEDURE: The patient was taken to the OR and placed in
dorsal lithotomy position, prepped abdominally and vaginally. The fundus was
massaged with expression of approximately 200 mL of clot. The vagina and
cervix was inspected. There was no evidence of cervical or vaginal
lacerations. The patient was placed in low lithotomy position, draped in
sterile manner. Staples removed. The incision was opened. The fascia was
opened. There was no unusual blood accumulation in the abdomen. The uterus
was boggy despite massage and intrauterine Hemabate. The uterine incision was
intact and dry. Uterus was elevated out of the abdomen. The uterine vessels
were identified by palpation and then sutured with a single stitch of #1
chromic at the level of the internal cervical os. The infundibulopelvic
ligaments were similarly sutured with a single throw of #1 chromic suture.
Several B Lynch sutures were placed and tightened while compressing the
uterus. The uterus was boggy and bulging and the bulging areas were sutured
down as well. The patient was then again examined vaginally. The uterine
cavity could be evaluated. There was no retained tissue or clots. This had
been done several times prior to surgery. A Bakri balloon was placed into the
uterus and filled initially with 300 mL of fluid. The patient still
experienced bleeding and was filled ultimately to 500 mL. The patient had no
bleeding from the drainage tube with the Bakri balloon, rather the bleeding
continued around the balloon from the cervix and lower uterine segment.
Careful inspection for bleeders. The cervix was grasped with ring forceps in
several places and sutured without improvement of the bleeding. The vagina
was tightly packed against the balloon. Initially, there was good hemostasis.
The abdomen was again inspected. The uterus, tubes and ovaries were
inspected. The ovaries appeared healthy. There is no oozing or unusual fluid
collection. The muscle subfascial area was dried. The fascia was closed with
0 PDS continuous running suture in 2 lengths. Subcutaneous layer was
approximated with 2-0 plain suture. Skin was closed with staples. At this
point, the patient was again examined and noted that the vaginal packing had
bled through. The vaginal packing was removed and was rung out with
approximately 50 mL of thin bloody fluid. Packing was repeated using lap
pads. The husband was notified of the difficult situation and possible need
for hysterectomy. The abdomen was again opened. Since the bleeding seemed to
be mostly from the lower uterine segment and cervix, the bladder was advanced
off the cervix and the cervix was closed front to back with #1 chromic
sutures. This provided good hemostasis although there was oozing from the
cervix. The vagina was again tightly packed 1st with just 1 packing. It was
observed for 5-10 minutes, was virtually dry and the rest of the vagina was
then packed tying all the lengths of gauze together. The abdomen was again
inspected. There was noted to be oozing from the uterus at the uterine
incisions and the uterine vessels which were secured. Again, the ovaries were
inspected and both looked healthy. Good hemostasis was obtained. The fascia
was closed with 0 PDS continuous running suture in 2 lengths. Subcutaneous
layer was irrigated, and skin was closed with staples. Pressure dressing
applied. The vagina was again inspected. The upper part of the packing was
damp, but not soaked. At the introitus, there was bleeding from
instrumentation and exams. These oozing areas were controlled with cautery
and 3-0 Vicryl suture as needed. The patient was oozing minimally at the end
of the procedure. It was felt that her blood loss could be kept up with and
the procedure without complication. Counts were correct. Estimated blood
loss during the procedure was 500 mL.
Thanks for all of the help I can get!
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