Question Sigmoid Granulomatous Mass

jdibble

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Help is needed on how to code this.

PATIENT IS BROUGHT TO THE OR ON 9/19/19 AND PLACED ON TABLE SUPINE POSITION. AFTER ADEQUATE GENERAL ANESTHESIA, SHE HAD A FOLEY CATHETER PLACED AND WAS PREPPED DRAPED STERILE FASHION. AN INFRAUMBILICAL INCISION WAS MADE AND A 5 MM BLADELESS TROCAR WAS PLACED UNDER DIRECT VISION IN THE BELLY WAS INSUFFLATED TO 15 MM HG PRESSURE. INSPECTION WAS UNDERTAKEN AFTER PLACING THE PATIENT IN TRENDELENBURG AND NO EVIDENCE OF A LEFT INGUINAL HERNIA WAS NOTED. NOR WAS THERE SEEN A RIGHT INGUINAL HERNIA DEFECT. ANOTHER INCISION WAS MADE IN THE LEFT MID QUADRANT AND A 5 MM BLADELESS TROCAR WAS PLACED UNDER DIRECT VISION THROUGH IT. THE LAPAROSCOPIC WAS MOVED TO THIS PORT AND A BABCOCK WAS USED THROUGH THE INFRAUMBILICAL PORT TO PALPATE THE ABDOMINAL WALL. NO DEFECTS NOR LAXITY WAS NOTED. THE SIGMOID COLON WAS LIFTED UP AND THERE WAS NOTED TO BE YELLOW GRANULOMATOUS MASS OFF THE EPIPLOICA. FURTHER RUNNING THE SIGMOID COLON REVEALED A BLUISH TINGED DIVERTICULUM AND ANOTHER SMALL COLONIC WALL LESION. INSPECTION ALONG THE SIDE WALL REVEALED NO OVARIAN REMNANTS NOR OTHER MASSES. ANOTHER INCISION WAS MADE IN THE RIGHT MID QUADRANT AND A 5 MM BLADELESS TROCARS PLACED UNDER DIRECT VISION THROUGH IT. THEN THE INFRAUMBILICAL INCISION WAS WIDENED AND A 10 11 MM TROCARS PLACED UNDER DIRECT VISION THROUGH IT. USING THE ENDO BABCOCK AND THE ENDO SHEARS ATTACHED ELECTRIC BOVIE CAUTERY, THE SIGMOID GRANULOMATOUS MASS WAS TAKEN OFF THE SIGMOID COLON AND REMOVED THROUGH THE INFRAUMBILICAL PORT.

MARCAINE 0.5% MIXED WITH 1 ML PER 40 MG OF KENALOG WAS INJECTED IN THE LEFT LOWER QUADRANT AND INGUINAL REGION UNDER DIRECT VISION. THE TROCARS REMOVED UNDER DIRECT VISION AND THE BELLY WAS ALLOWED TO DESUFFLATE. ACTIVE DESUFFLATION WAS UNDERTAKEN THE SUCTION IRRIGATOR. THE INCISIONS WERE INJECTED WITH THE SAME MARCAINE IN A MIXTURE. THE INFRAUMBILICAL INCISION WAS CLOSED IN 2 LAYERS WITH 0 VICRYL STITCH IN THE FASCIA AND A 4 MONOCRYL SUBCUTICULAR STITCH IN THE SKIN. THE OTHERS WERE CLOSED WITH 4 MONOCRYL SUBCUTICULAR STITCHES. MASTISOL, STERI-STRIPS, TELFA TEGADERM WERE PLACED FOR DRESSINGS. THE PATIENT WAS EXTUBATED IN THE OR AND TAKEN RECOVERY IN STABLE CONDITION. ALL COUNTS WERE CORRECT AT THE END THE CASE.

I am looking for a code for this laparoscopic procedure and am not sure what to use. If there is no code and I have to use an unlisted code would it be 44238 or 49329 and what would be a comparable code? I have looked at 49255 to compare but I am not sure that would be right! Help!! :)

Thank you!
 
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