Can both the removal of the spleen (38100) and suture of the mesentery (44850) be coded???
is a 55-year-old gentleman who underwent pancreaticoduodenectomy (Whipple procedure yesterday 11/05/2015). He initially remained stable, but then developed hypotensive episodes and clinical evidence of bleeding in the early morning hours today. He became hypotensive and bradycardic, and drain output became continuously bloody. There was no option, but to recommend taking him back to the operating room for exploration. Operative procedure, risks, benefits, and alternatives discussed, reviewed with the family in detail. Consent obtained.
DESCRIPTION OF PROCEDURE:
The patient was rapidly taken to the operating room. He already had been intubated, had monitoring lines in place. Nasogastric tube and Foley catheter were in place. He was placed on the operating room table. A massive transfusion protocol was initiated. Abdomen prepped and draped in routine manner. Time-out carried out to confirm the procedure to be done and the patient's identity. Previous staple lines removed. Abdomen opened.
The immediate findings were that again of a large amount of blood in the abdomen. Some of it was freshen and most of it was clotted. By the time it was through removing all the blood, it is estimated that he had close to 3-4 L of blood in the abdomen. Main findings were that of bleeding points in the left upper quadrant and in the area of the mesentery, area of the short gastric vessels, and area of the spleen. To control bleeding in this area necessitated going ahead with splenectomy.
The previous area of surgical site, including all the anastomoses, including the pancreaticojejunostomy, choledochojejunostomy, and gastrojejunostomy, were all found to be intact. Abdomen was copiously washed out. After washing it out, we inspected the abdomen again. There were no other fresh bleeding areas. Due to the free amount of fluid in the abdomen and the bleeding, we felt that multiple drains should be placed. I therefore placed 3 new drains, 2 on each side, 2 going towards the pelvis and 2 going into the colonic gutter, and 1 of them directed specifically in the area of the pancreaticojejunostomy. The abdomen was closed in layers. I used 0 PDS for the posterior fascia and 0 looped PDS for the anterior fascia. The skin approximated with staples. The patient appeared to stabilize.
The patient did receive multiple fluid infusions during this operation. He received 6 L of crystalloid, 18 L of packed red blood cells, 10 units of fresh frozen plasma, and 2 units of platelets. The entire procedure took 3 hours.
Estimated blood loss 3 L. Urine output 450 mL. The patient did stabilize and was taken directly to the critical care unit intubated, critical, but stable.
Any help with this would be greatly appreciated. Thank you
is a 55-year-old gentleman who underwent pancreaticoduodenectomy (Whipple procedure yesterday 11/05/2015). He initially remained stable, but then developed hypotensive episodes and clinical evidence of bleeding in the early morning hours today. He became hypotensive and bradycardic, and drain output became continuously bloody. There was no option, but to recommend taking him back to the operating room for exploration. Operative procedure, risks, benefits, and alternatives discussed, reviewed with the family in detail. Consent obtained.
DESCRIPTION OF PROCEDURE:
The patient was rapidly taken to the operating room. He already had been intubated, had monitoring lines in place. Nasogastric tube and Foley catheter were in place. He was placed on the operating room table. A massive transfusion protocol was initiated. Abdomen prepped and draped in routine manner. Time-out carried out to confirm the procedure to be done and the patient's identity. Previous staple lines removed. Abdomen opened.
The immediate findings were that again of a large amount of blood in the abdomen. Some of it was freshen and most of it was clotted. By the time it was through removing all the blood, it is estimated that he had close to 3-4 L of blood in the abdomen. Main findings were that of bleeding points in the left upper quadrant and in the area of the mesentery, area of the short gastric vessels, and area of the spleen. To control bleeding in this area necessitated going ahead with splenectomy.
The previous area of surgical site, including all the anastomoses, including the pancreaticojejunostomy, choledochojejunostomy, and gastrojejunostomy, were all found to be intact. Abdomen was copiously washed out. After washing it out, we inspected the abdomen again. There were no other fresh bleeding areas. Due to the free amount of fluid in the abdomen and the bleeding, we felt that multiple drains should be placed. I therefore placed 3 new drains, 2 on each side, 2 going towards the pelvis and 2 going into the colonic gutter, and 1 of them directed specifically in the area of the pancreaticojejunostomy. The abdomen was closed in layers. I used 0 PDS for the posterior fascia and 0 looped PDS for the anterior fascia. The skin approximated with staples. The patient appeared to stabilize.
The patient did receive multiple fluid infusions during this operation. He received 6 L of crystalloid, 18 L of packed red blood cells, 10 units of fresh frozen plasma, and 2 units of platelets. The entire procedure took 3 hours.
Estimated blood loss 3 L. Urine output 450 mL. The patient did stabilize and was taken directly to the critical care unit intubated, critical, but stable.
Any help with this would be greatly appreciated. Thank you
