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Thread: Laparoscopic assisted sigmoid colon resection

  1. #1

    Default Laparoscopic assisted sigmoid colon resection

    Hi,
    I am not sure if these are the correct codes and modifier for the following surgery. Should there be a separate code for the dcompression of ovarian cyst? would the assistant surgery append 80 to his surgery only? I did not think the primary physician that is doing the main PX would get the 80. The codes I have is 44204 and 44213 w/o 80 ( he is the primary physician) Thanks for your help!

    NAME OF OPERATION:
    1 Laparoscopic-assisted sigmoid colon resection.
    2 Take-down of splenic flexure and decompression of left ovarian cyst.
    ANESTHESIA: General anesthesia with intubation.
    ESTIMATED BLOOD LOSS: Approximately 100 cc.
    GROSS OPERATIVE FINDINGS: Upon entering the abdomen with the
    laparoscope, we immediately noticed some diverticulosis of the sigmoid
    colon. In addition to that, there was a large cystic mass consistent
    with a left ovarian cyst that was strongly adherent to the mid sigmoid
    colon. Both digital dissection as well as sharp dissection was used
    to slowly separate this structure from the sigmoid colon. The liver
    was otherwise smooth with no discernible pathology. There was no
    other pathology found in the pelvis except for the one just mentioned.
    DESCRIPTION OF OPERATION: The patient was brought to the operating
    room, positioned on the operating table in the lithotomy fashion.
    After induction of anesthesia with intubation, the abdomen was prepped
    and draped in the usual sterile fashion. Marcaine 0.5% plain was now
    used to infiltrate in the right upper quadrant subcostal midclavicular
    line and a 5 mm port was placed through this incision. Under direct
    laparoscopic vision, we now placed a 12 mm port through a
    supraumbilical incision and a second 12 mm port was now placed in the
    right lower quadrant in the pelvis region. Immediately, we switched
    to the 30 degree 10 mm scope and, using the LigaSure, we began taking
    down the attachment of the sigmoid colon, moving in a cephalad fashion
    towards the spleen. We first identified the white line of Toldt and
    began remobilizing our colon, again moving to the level of the splenic
    flexure. We now began going down towards the area of the pelvis
    region. Immediately, we encountered this large complex structure
    which appeared to be cystic in nature and what appeared to be a
    arising from the left ovaries. This structure likely represented a
    very large ovarian cyst. We identified the cyst and the cyst was now
    decompressed at this point in time to make dissection easier to carry
    out. Using the LigaSure, we began separating the structure in the
    left ovary away from the sigmoid colon. Once we were able to separate
    both structures, we were able to now lab retract it out of the way and
    continue mobilizing our sigmoid colon to the level of proximal rectum.
    We now placed a Gelport through a Pfannenstiel incision and turned
    the case to laparoscopic-assisted by placing my hand and I was able to
    now continued mobilizing the sigmoid colon again to the level of the
    proximal rectum. We now concentrated in going upwards and taking down
    our splenic flexure. Both digital blunt dissection as well as sharp
    dissection with the LigaSure was used to take the attachment of the
    colon to the area of the spleen so that we can mobilize it well and
    bring it all the way down to the pelvis and do an appropriate
    resection and anastomosis.
    Once we had mobilized the transverse, descending and sigmoid colon to
    satisfaction, we now went to the level of the proximal rectum at the
    level of the sacral promontory and we made a small hole on the
    mesentery of the distal sigmoid and proximal rectum area. We now used
    a 3.5 reticulator and the GIA positioned across it, closed and fired.
    We now began taking down the mesentery of blood supply using the
    LigaSure as we moved towards the spleen. Once we have taken down the
    mesentery, we were now able to bring now the entire specimen pretty
    much through our Gelport at which point we placed a bowel clamp across
    it, cut the specimen by the mid descending colon and passed the
    sigmoid over the table as a specimen. We now used our sizers and
    chose appropriate size EEA. The anvil was placed into the proximal
    colon and a reload on the 3.5 Endo-GIA was now used and positioned
    across the end of the colon, closed, and fired. The anvil was brought
    out proximal to our staple line. My assistant now went down to the
    area of the pelvis. He dilated the anus and rectum and brought in the
    shaft of the 28 EEA. We positioned it on the rectal stump, opened it,
    brought it together with the anvil, closed, and fired, creating our
    end-to-end anastomosis. We now tested anastomosis on the air while
    under saline to make sure there were no leaks. There were no leaks
    identified and no defect, but the area was then reinforced with
    seromuscular layer of 2-0 silk.
    At this time, the abdomen and pelvis were irrigated and, upon
    irrigation, closure was performed. Closure of the fascia defect by
    the Gelport was done with a running 1 PDS. Then the skin incision was
    done with 4-0 Monocryl in a subcuticular fashion. Port sites were
    closed also with 4-0 Monocryl in subcuticular fashion, followed by
    Benzoin and Steri-Strips. Patient tolerated procedure quite well.
    She was then taken to recovery in stable condition.

  2. #2
    Join Date
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    Default

    " We now placed a Gelport through a Pfannenstiel incision and turned
    the case to laparoscopic-assisted by placing my hand and I was able to
    now continued mobilizing"

    I pulled the above sentence from the operation report that you posted. I think the word "assisted" is referring to the technique, not that there was an assistant surgeon.

    The procedure was performed laparoscopic, but the incision is widened to allow a laparoscopic hand port to be place. The surgeon is then able to insert his/her hand into the "belly". My surgeon calls this technique laparoscopic hand assisted, __________. For coding purposes it is still considered laparoscopic, therefore code 44204 is correct. I would also consider billing 58662.

    Hope this helped-
    Melissa Jewett, CPC

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