need help with coding - ultrasonic scalpel

valariej

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Please help with coding. I am not able to figure this one out.



FINDINGS AND PROCEDURE: The abdomen overall was much improved from the prior exploration. The whole distal end of the omentum appeared to be necrotic, and this was excised using the LigaSure ultrasonic scalpel. The rectosigmoid stump that had been stapled with a GIA 50 appeared to have necrosis along the staple line. This was dissected down using the LigaSure and then GIA 60 fired twice to re-resect to a more viable portion of the rectum. The abdomen was then irrigated with copious amounts of normal saline. The GJ tube was inserted by making two circling pursestrings of the antrum of the stomach. Incision was made in the stomach, and the GJ tube was tunneled through the abdominal wall, and placed through the stomach pursestring and directed through the pylorus and the duodenum, and advanced through under the jejunum. The pursestring was then tied around the GJ tube, and the outer pursestring was also tied, and the stomach was sewn to the abdominal wall with 2-0 silk. The terminal ileum was examined.
The mesentery was taken down enough to be able to create an ileostomy. The skin incision was made, skin disc was removed on the right lower quadrant, and dissection was carried through the abdominal musculature. The ileum was delivered through the wound to the skin, and then the abdomen was closed using #1 PDS running sutures. Subcutaneous tissue was irrigated with normal saline. The skin was closed with staples. The ileostomy was then matured by cutting off the suture line and using rose-budding stitches with 2-0 Vicryl, was then matured to the ostomy site, and ostomy bag was placed. GJ tube was pulled up snug at 5 on the phalange of the GJ tube. The patient tolerated the procedure well, with no apparent complications.
 

btadlock1

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Please help with coding. I am not able to figure this one out.



FINDINGS AND PROCEDURE: The abdomen overall was much improved from the prior exploration. The whole distal end of the omentum appeared to be necrotic, and this was excised using the LigaSure ultrasonic scalpel. The rectosigmoid stump that had been stapled with a GIA 50 appeared to have necrosis along the staple line. This was dissected down using the LigaSure and then GIA 60 fired twice to re-resect to a more viable portion of the rectum. The abdomen was then irrigated with copious amounts of normal saline. The GJ tube was inserted by making two circling pursestrings of the antrum of the stomach. Incision was made in the stomach, and the GJ tube was tunneled through the abdominal wall, and placed through the stomach pursestring and directed through the pylorus and the duodenum, and advanced through under the jejunum. The pursestring was then tied around the GJ tube, and the outer pursestring was also tied, and the stomach was sewn to the abdominal wall with 2-0 silk. The terminal ileum was examined.
The mesentery was taken down enough to be able to create an ileostomy. The skin incision was made, skin disc was removed on the right lower quadrant, and dissection was carried through the abdominal musculature. The ileum was delivered through the wound to the skin, and then the abdomen was closed using #1 PDS running sutures. Subcutaneous tissue was irrigated with normal saline. The skin was closed with staples. The ileostomy was then matured by cutting off the suture line and using rose-budding stitches with 2-0 Vicryl, was then matured to the ostomy site, and ostomy bag was placed. GJ tube was pulled up snug at 5 on the phalange of the GJ tube. The patient tolerated the procedure well, with no apparent complications.
I can't tell from the note - did the patient already have a gastrostomy tube? If yes, use 49446 alone; if no, it may be 49440 & 49446

The ileostomy looks like 44310, to me - but I don't code a lot of GI. You may want to get a second opinion on this... :eek:
 
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