Wiki Return to OR following Cesarean

tgclarke

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CPT code help needed for patient that had a cesarean and 3 days later in the same hospital visit was taken back to the or for evacuation of rectus sheath hematoma and subcutaneous seroma.
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Description of procedure:
Following confirmation of planned procedure and planned transfusion of 1-2 units PRBC she was taken to the OR and placed supine on the OR table. SCD's were already in place. General anesthesia was induced. Her abdomen was evaluated and the dressing removed, with sero-sanguineous blood draining from a small wound opening on the left. Her bladder was drained of 300 mL clear yellow urine by straight cath. Her abdomen was prepped with betadine and draped in sterile fashion. A time out was complete. Ancef 3 grams were administered.

Her wound was opened sharply with scissors by cutting through the existing Insorb staples. The barbs were extracted by traction. The sub-cutaneous interrupted sutures were cut and the wound readily opened to the level of the fascia. No hematoma was found although there was considerable serous fluid. There were no bleeding sources identified in the sub-cutaneous tissues.

The fascia was opened sharply with scissors by cutting through the intact 0-vicryl closure of this level. Copious adherent clot was found beneath the fascia and above the muscle. This was removed manually with the surgeons gloved hands and by debridement with a dry lap sponge and by irrigation. Approximately 500-600 mL of clot were removed in this way. No active bleeding was observed on the muscle or the underside of the fascia. The peritoneum was intact. A careful observation and exploration of the exposed tissues found excellent hemostasis on all surfaces. As a precaution, FloSeal 10 mL was placed in the left upper corner of the dissection, between the fascia and the muscle, as the most likely source of the hematoma. The fascia was closed again with 0-vicryl running.

The subcutaneous tissues were again closely observed with excellent hemostasis noted. A sharp stab wound was made above and lateral to the left corner of the existing incision. The tubing for a J-P drain was threaded through this wound bluntly. The perforated portion of the drain was shortened to fit within the base of the incision against the fascia. The subcutaneous tissues were re-approximated with 3 buried interrupted sutures of 0 chromic, ensuring the drain was not caught within them. The skin was closed with Insorb.
 
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