Wiki No laparoscopic code?

Create Wiki
C

Callieb

Guest
Messages
43
Location
Crestwood, KY
Best answers
0
Patient had perforated rectal cancer. Dr did end colostomy with mucous fistula creation. This was ALL done laparoscopically. The open code would be 44144 but there is no lap code. Any suggestions?
 
Here Goes -
We began by placing left lower quad 10mm laparoscopic trocar under optiview approach. Once gaining intrance into peritoneal cavity abdomen wasinsufflated. Then placed 2 right lower quad 5mm trocars under direct visualization. Using lap grasper sigmoid colon was grasped and retracted away from retroperitoneal attachment of its mesentery. Good mobility, however palpably large stool burden throughout sigmoid colon leading to rectum. Using scalpel a small window in sigmoid messentery was created medially and again laterally and using blunt dissector two holes wereconnected intil small tunnel was created in mesentery. Then transected colon using lap GIA stapler
Using harmonic scalpel sig colon mesentery was freed to allow for mobilization of both proximal end as well as distal rectal stump in hopes of creating mucous fistula.Then grasped sig colon staple line thru the 10mm trocar and excised an ellipse of skin arount the trocar. Anterior adn posterior rectus sheathes were longitudinally opened using Bovie electrocautery above and below the 10mm trocar. Once we could fit 2 fingers around the trocar through the rectus fascia and into the peritoneum the trocar was then removedand colon end was then withdrawn out of our created ostomy incision.We then cut smaller elliptical incision out of the inferior left lower quad skin just below our colostomy to fashion our mucous fistula here. The abdomen was again insufflated and using grasper the distal rectal stump was elevated up towards the anterior abd wall.
Again the mucous fistula ostomy site was opened through the anterior and posterior rectus sheath in a longitudinal fashion using Bovie adn through this
incision the distal rectal stump was grasped and elevated our fo the wound to the intraabdominal wall. Abdomen was then desufflated adn the colostomy mucous fistula were both matured in standard fashion. At completion the abd was again insufflated to inspect and then desufflated and both 5mm rt lower quad trocars were retracted out of abd. both incisions were closed. Ostomy and m fistula were both dressed.
 
It looks like he created both stomas without a resection. How about 44188-22 and send in report to document the additional work of creating the Mucofistula.
 
what a decision! 44144 is a higher rvu which means lap procedure would pay more but did not want to use an unlisted code. they always say to use any other code if possible instead of unlisted. 44188 is a thought but don't like modifier 22 either. Patient has a humana medicaid plan. Any other opinions before I post this?
 
You must log in or register to reply here.
Top