rockylopez
Networker
Hello Everyone. I have been doing my research for diagnostic laparotomy with closure of uterine rupture at 31 weeks. I am between the 49320 or since this is OB related and related delivery due to uterine rupture I can bill cpt code 59514 with the closure of uterine rupture 59350?
any input is appreciated.
Pre-procedure diagnosis:
Hemoperitoneum
Post-procedure diagnosis:
IUP at 31 weeks with uterine rupture and hemoperitoneum
Procedures performed:
Diagnostic Laparotomy (Vertical skin incision) with closure of uterine rupture
Technique/Procedure:
Patient was prepped and draped in a sterile fashion. Once general anesthesia induced a vertical skin incision was made sharply with the knife and extended through the subcutaneous tissue to the fascia with electrocautery. The fascia was opened superiorly and inferiorly and upon entrance in the abdomen large amounts of blood encountered, evacuated manually and with pooled suction. An alexis retractor was placed in the abdomen and cinched in place. At this time the amniotic sac was visible with obvious evidence of uterine rupture. The amniotic sac was opened with Allis clamp and clear fluid noted. Infant delivered from the cephalic presentation without tone and the cord was doubly clamped and cut and the baby handed to Dr __ in attendance. A segment of cord was cut for gases and cord blood obtained. The uterus was exteriorized and a vertical opening in the uterus was noted; placenta delivered manually/intact. The uterine defect was closed with 0-vicryl in a running locking fashion vertically approximating the muscular portion with minimal amount of bleeding and the uterus reinserted in the abdomen for trauma surgeon to evaluate for any other source of bleeding; see the dictation for details. The uterus was exteriorized again and a second layer placed in the uterine defect with 0-vicryl though the muscular and serosal layers. Bleeding was noted in the mid portion of the defect hemostatic with 0-vicryl with a transfixion suture. Once adequate hemostasis surgicel powder applied to the repair and the alexis retractor was removed. The fascia was closed with 0 vicryl in a running fashion and the subcutaneous tissue irrigated and hemostasis with electrocautery. 2-0 vicryl in a running fashion utilized in the subcutaneous area followed by stapled to close the skin. A dressing was placed above the incion and the vaginal area evaluated after drapes off; adequate uterine tone and small lochia noted. Patient transferred to the recovery room upon conclusion of procedure.
Operative findings:
Spontaneous uterine rupture (Vertical). Large amount of blood/clots in the abdomen and pelvis with bowel/omental adhesions to the anterior abdominal wall.
Viable female 3#14 ounces apgar 3/5/6 at 1438 hrs in cephalic presentation
Specimens removed/altered: none
any input is appreciated.
Pre-procedure diagnosis:
Hemoperitoneum
Post-procedure diagnosis:
IUP at 31 weeks with uterine rupture and hemoperitoneum
Procedures performed:
Diagnostic Laparotomy (Vertical skin incision) with closure of uterine rupture
Technique/Procedure:
Patient was prepped and draped in a sterile fashion. Once general anesthesia induced a vertical skin incision was made sharply with the knife and extended through the subcutaneous tissue to the fascia with electrocautery. The fascia was opened superiorly and inferiorly and upon entrance in the abdomen large amounts of blood encountered, evacuated manually and with pooled suction. An alexis retractor was placed in the abdomen and cinched in place. At this time the amniotic sac was visible with obvious evidence of uterine rupture. The amniotic sac was opened with Allis clamp and clear fluid noted. Infant delivered from the cephalic presentation without tone and the cord was doubly clamped and cut and the baby handed to Dr __ in attendance. A segment of cord was cut for gases and cord blood obtained. The uterus was exteriorized and a vertical opening in the uterus was noted; placenta delivered manually/intact. The uterine defect was closed with 0-vicryl in a running locking fashion vertically approximating the muscular portion with minimal amount of bleeding and the uterus reinserted in the abdomen for trauma surgeon to evaluate for any other source of bleeding; see the dictation for details. The uterus was exteriorized again and a second layer placed in the uterine defect with 0-vicryl though the muscular and serosal layers. Bleeding was noted in the mid portion of the defect hemostatic with 0-vicryl with a transfixion suture. Once adequate hemostasis surgicel powder applied to the repair and the alexis retractor was removed. The fascia was closed with 0 vicryl in a running fashion and the subcutaneous tissue irrigated and hemostasis with electrocautery. 2-0 vicryl in a running fashion utilized in the subcutaneous area followed by stapled to close the skin. A dressing was placed above the incion and the vaginal area evaluated after drapes off; adequate uterine tone and small lochia noted. Patient transferred to the recovery room upon conclusion of procedure.
Operative findings:
Spontaneous uterine rupture (Vertical). Large amount of blood/clots in the abdomen and pelvis with bowel/omental adhesions to the anterior abdominal wall.
Viable female 3#14 ounces apgar 3/5/6 at 1438 hrs in cephalic presentation
Specimens removed/altered: none
