jordan0801
New
Hi, Is there a specific code to use when small bowel bypass was done during small bowel resection? I'm thinking to code 44120 for small bowel resection but im not sure if there's a specific code for small bowel resection and internal bowel bypass? my first thought is to code 44130 but can't billed 44120 and 44130 together. Or is the small bowel resection bundled into cpt 44130? Thank you.
Procedure Details
Under general anesthesia with endotracheal intubation abdominal pelvis was prepped with ChloraPrep and sterilely draped. Foley catheter was placed upon induction. Patient did receive preoperative antibiotics. Lower midline laparotomy was performed through the old scar. The incision was extended few centimeters above the umbilicus and out to go through the virgin belly. Skin subcutaneous tissue and midline fascia was entered. The small bowel's were eviscerated. There were multiple implants on the side of the small bowel throughout. The distal small bowel was tethered to the right pelvic wall. This was released I have to take small amount of lateral pelvic wall peritoneum. This was the major point of obstruction. There were other strictures proximally likely from implants. Decision was made to perform a distal small bowel resection where it was tethered to the right pelvic wall as it was obstructing as well as internal small bowel bypass of area of small bowel proximal to the resected small bowel as the stricture was tight with impending obstruction. There were other less tight strictures which were left alone. Mesenteric window was created and the small bowel was resected with Endo GIA blue load proximally and distally. A side-to-side functional end-to-end anastomosis was performed with Endo GIA blue load. The common enterotomy was closed with TA blue load. This was subsequently infiltrated with 2-0 Vicryl suture. The mesenteric window was closed with 2-0 silk suture. Crotch suture was placed at the end of the anastomosis. The internal small bowel bypass was performed again with Endo GIA blue load. The common enterotomy was closed in 2 layers with 2-0 Vicryl full-thickness and 3-0 silk suture seromuscular. I tested both anastomosis with no leak. There was some bleeding from the right pelvic wall where the bowel was tethered. Hemostasis achieved. I also placed Surgicel and Floseal for additional hemostasis.
Procedure Details
Under general anesthesia with endotracheal intubation abdominal pelvis was prepped with ChloraPrep and sterilely draped. Foley catheter was placed upon induction. Patient did receive preoperative antibiotics. Lower midline laparotomy was performed through the old scar. The incision was extended few centimeters above the umbilicus and out to go through the virgin belly. Skin subcutaneous tissue and midline fascia was entered. The small bowel's were eviscerated. There were multiple implants on the side of the small bowel throughout. The distal small bowel was tethered to the right pelvic wall. This was released I have to take small amount of lateral pelvic wall peritoneum. This was the major point of obstruction. There were other strictures proximally likely from implants. Decision was made to perform a distal small bowel resection where it was tethered to the right pelvic wall as it was obstructing as well as internal small bowel bypass of area of small bowel proximal to the resected small bowel as the stricture was tight with impending obstruction. There were other less tight strictures which were left alone. Mesenteric window was created and the small bowel was resected with Endo GIA blue load proximally and distally. A side-to-side functional end-to-end anastomosis was performed with Endo GIA blue load. The common enterotomy was closed with TA blue load. This was subsequently infiltrated with 2-0 Vicryl suture. The mesenteric window was closed with 2-0 silk suture. Crotch suture was placed at the end of the anastomosis. The internal small bowel bypass was performed again with Endo GIA blue load. The common enterotomy was closed in 2 layers with 2-0 Vicryl full-thickness and 3-0 silk suture seromuscular. I tested both anastomosis with no leak. There was some bleeding from the right pelvic wall where the bowel was tethered. Hemostasis achieved. I also placed Surgicel and Floseal for additional hemostasis.