herrera4
Guru
I could use some help with this note...the codes im thinking are open and I dont think I can charge for appy but want to make sure, I still get confused when its performed at time of other surgery-it appeared to be healthy. Then the whole epiploic appendage kinda through me for a loop...any help
DETAILS OF THE PROCEDURE: ......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........
DETAILS OF THE PROCEDURE: ......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........