Robotic assistance of resection of endometriosis and ureterolysis

tonyabcarr

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My surgeon performed a procedure using robotic assistance when excising endometriosis in the pelvis, diaphragm, bladder and ureters. Excision of endometriosis hopefully in the future will be more site and method specific, but for now is generally coded in 58662. I have attached the op note. Please advise if anyone thinks I can add another code for the diaphragm excision or ureterolysis.

Procedure Performed:
1. Robot resection of endometriosis in the pelvis with left ureterolysis
2. Resection of diaphragmatic endometriosis extended service

Description of Procedure:
The patient was taken to the operating room where general anesthesia was induced. She was prepped and draped in the normal sterile fashion and catheter was inserted in the bladder. A manipulators placed in the uterus.
A 10-mm infraumbilical skin incision was made and a Veress needle was inserted. The opening pressure was 4, and the abdomen was insufflated with carbon dioxide gas to make the pressure 20. The Veress needle was removed and a 10-mm trocar was placed after the abdomen was tended. The laparoscope was inserted and found to be in the peritoneal cavity. The peritoneum was free of injury. An 8-mm trocars were placed on either side, and assistance were placed. The robot was docked and I sat down at the console. We docked the robot from the right shoulder location in order to reach the diaphragmatic endometriosis. The diaphragm contains 5 visible spots of the endometriosis. These were resected using scissors and bipolar cautery. There was 3 spots underneath the right lobe of the liver and each were cauterized using the bipolar cautery. All of the rest of the diaphragmatic surface that was visible as inspected and there were no other endometriosis spots that were seen. The robot was undocked and then redocked.

There was about 100 spots of the endometriosis in the pelvis, but no adhesions, the left-sided endometriosis was very densely implanted over the left ureter. The left ureter was carefully dissected out from the endometriosis. This took much longer than normal secondary to the proximity of the ureter. Finally, the ureter was dissected out in its entirety and all of the endometriosis that was seen was excised. The ovaries and fallopian tubes were normal. The uterus was normal. There were adhesions from the bladder to the uterus, and these were lysed and endometriosis around the bladder was resected. Interceed was placed behind the ovaries, where the endometriosis had been resected. The manipulator was removed. The lateral trocars removed under direct vision with good hemostasis, and the abdomen was completely deflated on all endometriosis that was visible in the pelvis. The upper abdomen had been completely excised. The patient was taken to the recovery room in stable condition.

I coded 58662-22, S2900. Any suggestions for additional codes?
 
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