Total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, nodes/appendix stump/ colon tumor removal HELP!

South Lake Tahoe, CA
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I have this surgical case that is making my head spin. I want to say 58954, 44955 and maybe 44110 for the removal of tumors from the colon. However I am not sure is the colon tumors are included in 58954 and since only the stump of the appendix is removed can I still captured 44955. With this all said the Pathology report does reveal all specimens collected are positive for high grade carcinoma.

total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymphadnectomy, right para-aortic lymphadnectomy, repair of cystotomy, omentectomy, bilateral pelvic side wall stripping, omentectomy, appendiceal stump removal, fulguration of tumor on peritoneal surface, radical tumor debulking
After informed consent was obtained the patient was brought to the operating room she was given adequate general anesthesia. She is prepped and draped in normal sterile fashion in dorsolithotomy position. A timeout confirming correct patient procedure were performed. Foley catheter was placed in the bladder a midline skin incision was made and carried down to the underlying fascia. The fascia was incised the midline peritoneum identified tented up and entered sharply. The incision was extended in a cephalad to caudad manner. The anterior abdominal wall was retracted with the Bookwalter retractor. The omentum was then pulled up from the incision and starting at the infrahepatic portion of the omentum was dissected off the right upper quadrant sidewall the inferior aspect of the transverse colon, the short gastrics were sacrificed and the omentum, supra colic, was dissected off the spleen and the left splenic flexure. It was then sent to pathology and sent for frozen section. Tumor on the right hemidiaphragm was then scraped off with no gross residual disease. The bowel was run from the ligament of Treitz to the appendix. There was small implants of tumor on the mesentery that were resected with sharp dissection. The appendix stump had a gross tumor adherent to it. The right pelvic to the white line of Toldt was dissected out from the appendiceal stump and portion of the cecum was ligated with a GIA 75. This was sent to pathology. The stump of the appendiceal region was then imbricated with a 2-0 Vicryl stitch. Tumor on the sigmoid colon was resected. The round ligament and the right was then incised the retroperitoneal space were opened. The right IP was noted to be free from the right ureter. The right IP was clamped coagulated cut. The right ureter was tagged with a vessel loop. The bladder flap created anteriorly there was some tumor on the bladder flap and dissected it out a small cystotomy was made at the dome of the bladder. This was repaired with 3-0 Vicryl at the mucosal level and then imbricated with a 2-0 Vicryl stitch. The rest of the bladder flap was then taken down with incorporation of this tumor. The round ligament on the left was incised retroperitoneal space were opened the left IP was noted to be free from left ureter. A vessel loop was placed underneath the left ureter. The tumor on the left pelvic sidewall was then dissected down the paravesical and pararectal space was developed. The left and right uterine artery was skeletonized clamped coagulated cut. The bladder flap was completely taken down. 2 large Z clamps were placed underneath the cervix, the uterus tubes and ovaries were amputated and sent to pathology. The vaginal cuff was closed with 0 Vicryl interrupted manner. Using the LigaSure and the Bovie the right and left pelvic sidewalls were removed as these had surface tumor on them. There was tumor on the rectovaginal septum. The rectovaginal space was developed and the tumor overlying this was taken off the peritoneal surfaces. It was sent to pathology. The abdomen was copiously irrigated. Enlarged lymph nodes in the right pelvic region were dissected out and sent to pathology mainly in the obturator space and overlying the external iliac artery and vein. Attention was then turned to the left side which in a similar manner the lymph nodes overlying the obturator space and the external iliac artery and vein were taken and sent to pathology. There was no enlarged left periodic lymph nodes. There was an enlarged right. Lymph node that was dissected out and sent to pathology. At this time I fulgurated tumor with the Bovie on residual peritoneal surfaces that appeared to have small implants of tumor. The abdomen was copiously irrigated. Surgi-Flo powder was placed in the pelvis and on the retroperitoneal spaces.

Pathology specimens)positive for carcinoma: Tissues A. Omentum - Biopsy - OMENTUM B. Colon - Segmental Resection For Tumor - SMALL BOWEL C. Omentum - Biopsy - MESENTARY FOR TUMOR D. Ovary - With Or Without Tube - Neoplastic - LEFT OVARY TUMOR E. Uterus - Neoplastic - CERVIX, UTERUS, BILATERAL TUBES AND OVARIES F. Omentum - Biopsy - RIGHT PELVIC SIDE WALL G. Lymph Node - Biopsy - RIGHT PELVIC LYMPH NODE H. Lymph Node - Biopsy - LEFT PELVIC LYMPH NODE I. Colon - Segmental Resection For Tumor - RIGHT COLON J. Appendix - Incidental - APPENDIX K. Lymph Node - Biopsy - RIGHRT PERI AORTIC LYMPH NODE L. Omentum - Biopsy - LEFT PELVIC SIDE WALL