44141 Open vs 44238 (Laparoscopic) would be your code range for this. But I wondering is this is 44206 (hartman).
Hope this helps
Thank you so much for your reply.
I uploaded the note for review--i should've added it earlier.
A timeout was performed. I made an incision above the umbilicus and dissected down to the anterior fascia. This was opened. I then opened the posterior fascia and peritoneum and placed a Hassan within the abdomen. I insufflated the abdomen. I placed a suprapubic 5 mm port under direct visualization and a left lower quadrant port under direct visualization. The patient was placed in the left side down position and Trendelenburg.
I inspected the abdomen. There is no evidence of Crohn's disease or any small bowel inflammation. The patient had a chronically dilated appendix. There is multiple adhesions from the retroperitoneum to the terminal ileum mesentery which I took down sharply. Once this was performed I have much more length. My I then performed a medial to lateral dissection of the ileocolic pedicle. I ligated this with multiple firings of the LigaSure. I took this at the base of the mesentery given the odd appearance of the appendix. There is 1 enlarged lymph node within the mesentery that was visible. This was part of my eventual specimen. I then dissected all the way up to the middle colic vessels which were large. I ended my dissection here. I then put a port at the likely ileostomy site which was previously marked using a 5 mm port with direct visualization. I then performed a full splenic flexure mobilization. There is a ton of adhesions on the left side and at the flexure. I dissected this. I then dissected the descending colon and the sigmoid colon off the retroperitoneum. There were dense adhesions due to the chronic inflammation.
I then ligated the left colic artery and dissected all the way up the mesentery to the middle colic vessels again. At this point I made a small incision where the Hassan was in place a small Alexis within this. I extracorporealized the descending colon, transverse colon, ascending colon and part of the terminal ileum. I dissected the mesentery flush with the end of the terminal ileum and I fired an 80 mm blue load GIA stapler across this retaining all of the terminal ileum. I then cleared off the mesentery at the distal sigmoid and fired an 80 mm blue load stapler across this. I used a 3-0 Vicryl to buttress the staple line to prevent a rectal stump blowout.
I then used a Carmalt clamp across the middle colic vessels. I ligated this using a 2-0 Vicryl stick tie.
The specimen was sent to pathology. I ran the entire small bowel to the ligament of Treitz. This was all normal and no evidence of inflammation. I cut a circle of skin at the ileostomy site which she had recently been a 5 mm port. I dissected down to the anterior fascia and made a cruciate incision. I split the rectus muscles and made a cruciate incision in the peritoneum. I then was able to get 2 fingers within this and I brought the terminal ileum up through this after making sure the mesentery was straight.
I then used a closing tray and changed gowns and gloves. We closed the fascia with two #1 PDS sutures. We closed the subcutaneous tissues with 3-0 Vicryl. I closed the skin at the 2 remaining port sites and the extraction site with a 4-0 Monocryl. Steri-Strips were applied. This was covered. The ileostomy was matured in the usual Brooke fashion. I injected 10 mL of quarter percent bupivacaine with epinephrine. This had great height and no puckering. This should pouch nicely. Counts are correct. No complications. EBL 50 mL.