herrera4
Guru
ok 44238 was billed for the epiploic appendage-op notes sent in and was denied
any others codes i overlooked?? TIA
DETAILS OF THE PROCEDURE: The patient was brought to the Operating Room and placed in supine position. Following induction of anesthesia, she was prepped and draped in the usual sterile fashion using ChloraPrep. After infiltration of local anesthetic, abdomen was entered through a curvilinear incision at the inferior aspect of the umbilicus. Umbilical hernia sac was identified as we separated the umbilical skin and was resected. Fascial edges were freshened and a 12 mm port was placed. The pneumoperitoneum was established and the patient was placed in reverse Trendelenburg position. The procedure was difficult due to the patient's body habitus. Additional ports were placed in the left lower quadrant times two as well as suprapubic port. These were 5 mm ports. The abdomen was inspected and with some difficulty, the patient was rolled to the left. This afforded view of the appendix and its appendiceal base. Appendix was resected using endo-GIA with the tan load 60 mm. Appendix was placed in endobag and extracted through the umbilical port. Attention was then turned toward the sigmoid colon. Sigmoid colon was run and indeed there were two areas of epiploic fat which were in fact fused together. One area had undergone infarction and fat necrosis. This formed an internal hernia and it was felt this would likely be greatly contributing to the patient's chronic pain. Accordingly, the epiploic appendage was resected using endo-GIA with the vascular loads. Final irrigation was carried out. There was no bleeding noted. Ports were withdrawn under direct visualization and port sites were closed with interrupted sutures of 0 Vicryl. This was used to repair the umbilical hernia defect using figure-of-eight sutures followed by 3-0 and subcuticular 4-0 Vicryl for the skin. This was followed by Steri-Strips, dry sterile dressing and Tegaderm.
any others codes i overlooked?? TIA
DETAILS OF THE PROCEDURE: The patient was brought to the Operating Room and placed in supine position. Following induction of anesthesia, she was prepped and draped in the usual sterile fashion using ChloraPrep. After infiltration of local anesthetic, abdomen was entered through a curvilinear incision at the inferior aspect of the umbilicus. Umbilical hernia sac was identified as we separated the umbilical skin and was resected. Fascial edges were freshened and a 12 mm port was placed. The pneumoperitoneum was established and the patient was placed in reverse Trendelenburg position. The procedure was difficult due to the patient's body habitus. Additional ports were placed in the left lower quadrant times two as well as suprapubic port. These were 5 mm ports. The abdomen was inspected and with some difficulty, the patient was rolled to the left. This afforded view of the appendix and its appendiceal base. Appendix was resected using endo-GIA with the tan load 60 mm. Appendix was placed in endobag and extracted through the umbilical port. Attention was then turned toward the sigmoid colon. Sigmoid colon was run and indeed there were two areas of epiploic fat which were in fact fused together. One area had undergone infarction and fat necrosis. This formed an internal hernia and it was felt this would likely be greatly contributing to the patient's chronic pain. Accordingly, the epiploic appendage was resected using endo-GIA with the vascular loads. Final irrigation was carried out. There was no bleeding noted. Ports were withdrawn under direct visualization and port sites were closed with interrupted sutures of 0 Vicryl. This was used to repair the umbilical hernia defect using figure-of-eight sutures followed by 3-0 and subcuticular 4-0 Vicryl for the skin. This was followed by Steri-Strips, dry sterile dressing and Tegaderm.