jdibble
True Blue
My surgeon did a surgery which appears to be a co-surgery with the GYN. The patient had a large mass that was attached to the colon, as well as the ovary. They both have documented their portions. The following is my surgeon's portion. If someone could look at this and help me with some codes it would be appreciated! I have thought of 44604 for the colostomy repair, but wasn't sure if I should be coding that or the excision of the mass - but it appears that they both worked on excising that. I am also unclear as to which code to use for the lymphadenectomy - 38760, 38765 or 38770? Or another code? Any help with codes and the rational would be great! (Also posted on the General Surgery forum with no responses!)
PREOPERATIVE DIAGNOSIS: Left ovarian mass.
POSTOPERATIVE DIAGNOSIS: Left ovarian cancer.
OPERATION: See Dr. R dictation for all procedures. Particular procedures: Lysis of adhesions, sigmoid colotomy repair, and bilateral inguinal lymphadenectomy.
ANESTHESIA: General endotracheal and postoperative TAP block.
ESTIMATED BLOOD LOSS: 1900 mL. One unit replaced in the OR.
SPECIMEN: See Dr. R's for complete list of specimen, but left ovary capsule, with washings for cytology, bilateral inguinal lymph nodes.
FINDINGS: Large left ovarian cyst and tumor extending past the umbilicus. It densely adhered to the sigmoid colon. Hydroureter on the left. Dense adhesions to the pelvic sidewall and surrounding structures.
INDICATIONS FOR PROCEDURE: The patient is a 59-year-old woman who had seen Dr.
R and was scheduled for surgery to undergo this left oophorectomy, but due to the size and findings on CAT scan, it was decided that she would possibly need extensive lysis of adhesions, possible dissection of the bowel. So, she was seen by me and discussed the possible risks, benefits, and complications of lysis of adhesions, possible bowel removal and repair and lymphadenectomy. She understood and agreed to proceed with the surgery.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR on 01/14/16 and placed on the table in supine position. After she had placement of a Foley and general anesthesia, she had a cystoscopy done and ureteral stent on the right was placed by Dr. G, but one could not be placed on the left. Then, the procedure was performed. The patient was opened by Dr. R and continued the procedure. Intraoperatively, required me to sharply dissected the sigmoid colon off of the right side of the large cystic mass. This inadvertently in dissection created a colotomy. Dissection continued to be taken down to the pelvis, superiorly and posteriorly, until finally it was dissected free from it.
The area was marked. We continued to take out the large mass, and once this was actually decompressed and removed, attention was directed back to the sigmoid colon. The colotomy was closed in 2 layers with a 3-0 Vicryl full stitch and then lambert stitches of 3-0 silk stitches. Then, the serosal tear was repaired with 3-0 silk lambert stitches. Once the pathology frozen section was obtained, then attention was directed initially to the left inguinal region and the nodes in the left inguinal region along the iliacs were carefully dissected out, and using clips to ligate the lymphatics. Once these were removed, there were noted to be at least 3 sizable lymph nodes. The ureter was noted on that side to have a hydroureter and it was distended.
Attention was then directed to the right inguinal region. The peritoneum was entered and dissection was undertaken to open it up further. Then, the fat pad along the iliacs was carefully dissected out. The lymph nodes were removed, clipping the lymphatics with Ligaclips. Once this was performed, then the remaining portion of the procedure was continued with Dr. R. Please see his dictation for the remaining procedure.
Any help would be greatly appreciated!
Thanks,
PREOPERATIVE DIAGNOSIS: Left ovarian mass.
POSTOPERATIVE DIAGNOSIS: Left ovarian cancer.
OPERATION: See Dr. R dictation for all procedures. Particular procedures: Lysis of adhesions, sigmoid colotomy repair, and bilateral inguinal lymphadenectomy.
ANESTHESIA: General endotracheal and postoperative TAP block.
ESTIMATED BLOOD LOSS: 1900 mL. One unit replaced in the OR.
SPECIMEN: See Dr. R's for complete list of specimen, but left ovary capsule, with washings for cytology, bilateral inguinal lymph nodes.
FINDINGS: Large left ovarian cyst and tumor extending past the umbilicus. It densely adhered to the sigmoid colon. Hydroureter on the left. Dense adhesions to the pelvic sidewall and surrounding structures.
INDICATIONS FOR PROCEDURE: The patient is a 59-year-old woman who had seen Dr.
R and was scheduled for surgery to undergo this left oophorectomy, but due to the size and findings on CAT scan, it was decided that she would possibly need extensive lysis of adhesions, possible dissection of the bowel. So, she was seen by me and discussed the possible risks, benefits, and complications of lysis of adhesions, possible bowel removal and repair and lymphadenectomy. She understood and agreed to proceed with the surgery.
DESCRIPTION OF PROCEDURE: The patient was brought to the OR on 01/14/16 and placed on the table in supine position. After she had placement of a Foley and general anesthesia, she had a cystoscopy done and ureteral stent on the right was placed by Dr. G, but one could not be placed on the left. Then, the procedure was performed. The patient was opened by Dr. R and continued the procedure. Intraoperatively, required me to sharply dissected the sigmoid colon off of the right side of the large cystic mass. This inadvertently in dissection created a colotomy. Dissection continued to be taken down to the pelvis, superiorly and posteriorly, until finally it was dissected free from it.
The area was marked. We continued to take out the large mass, and once this was actually decompressed and removed, attention was directed back to the sigmoid colon. The colotomy was closed in 2 layers with a 3-0 Vicryl full stitch and then lambert stitches of 3-0 silk stitches. Then, the serosal tear was repaired with 3-0 silk lambert stitches. Once the pathology frozen section was obtained, then attention was directed initially to the left inguinal region and the nodes in the left inguinal region along the iliacs were carefully dissected out, and using clips to ligate the lymphatics. Once these were removed, there were noted to be at least 3 sizable lymph nodes. The ureter was noted on that side to have a hydroureter and it was distended.
Attention was then directed to the right inguinal region. The peritoneum was entered and dissection was undertaken to open it up further. Then, the fat pad along the iliacs was carefully dissected out. The lymph nodes were removed, clipping the lymphatics with Ligaclips. Once this was performed, then the remaining portion of the procedure was continued with Dr. R. Please see his dictation for the remaining procedure.
Any help would be greatly appreciated!
Thanks,