bumkin81
Guest
Need help coding the peritoneal hematoma. I need a cpt. Anyone that could help would be greatly appreciated
DESCRIPTION OF PROCEDURE: The patient was brought in the operating room, she and operative site confirmed. She received a general anesthetic without incident. The abdomen prepped and draped in a standard fashion. I made a paramedian incision over the lateral edge of the rectus at the most tense part of the hematoma incorporating the peritoneal dialysis catheter exit site and excised that piece of skin along with the specimen and came down through the anterior rectus sheath and encountered the huge hematoma that had dissected out the axillary hairline on the left and to the midline medially down to the scar from the old transplant and up to the costal margin. We evacuated all of that the best we could and debrided some dead muscle and some of the dead or damaged fat, encountering a couple of bleeders, transfascial arteries that feed the subcutaneous tissue that had sheared off during and the expansion and probably contributed to the hematoma. There was some bleeding from the fascial perforation site at the top of the incision where the catheter exited through the fascia, and as I entered through there to find the hematoma, I suspect there was a bleeder in that muscle area where the catheter exited that started the whole process. That muscle was all destroyed just from pressure necrosis and had sort of ripped away. The evacuation was completed, irrigation performed and FloSeal was performed and smoothed out on all the cavity wall. Two Jackson-Pratt drains were left in the wound and then the anterior rectus sheath was reapproximated as best we could with a running 3-0 Vicryl, subcutaneous tissue with a few interrupted sutures and then the skin with surgical staples. The drain was secured to the skin with 3-0 nylon. Exparel had been injected all along the most lateral portion of the abdominal wall to try to control the pain postoperatively. She tolerated the procedure fine, transferred back to recovery room in satisfactory condition.
DESCRIPTION OF PROCEDURE: The patient was brought in the operating room, she and operative site confirmed. She received a general anesthetic without incident. The abdomen prepped and draped in a standard fashion. I made a paramedian incision over the lateral edge of the rectus at the most tense part of the hematoma incorporating the peritoneal dialysis catheter exit site and excised that piece of skin along with the specimen and came down through the anterior rectus sheath and encountered the huge hematoma that had dissected out the axillary hairline on the left and to the midline medially down to the scar from the old transplant and up to the costal margin. We evacuated all of that the best we could and debrided some dead muscle and some of the dead or damaged fat, encountering a couple of bleeders, transfascial arteries that feed the subcutaneous tissue that had sheared off during and the expansion and probably contributed to the hematoma. There was some bleeding from the fascial perforation site at the top of the incision where the catheter exited through the fascia, and as I entered through there to find the hematoma, I suspect there was a bleeder in that muscle area where the catheter exited that started the whole process. That muscle was all destroyed just from pressure necrosis and had sort of ripped away. The evacuation was completed, irrigation performed and FloSeal was performed and smoothed out on all the cavity wall. Two Jackson-Pratt drains were left in the wound and then the anterior rectus sheath was reapproximated as best we could with a running 3-0 Vicryl, subcutaneous tissue with a few interrupted sutures and then the skin with surgical staples. The drain was secured to the skin with 3-0 nylon. Exparel had been injected all along the most lateral portion of the abdominal wall to try to control the pain postoperatively. She tolerated the procedure fine, transferred back to recovery room in satisfactory condition.