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Thread: Laparoscopic Cecectomy

  1. #1

    Default Laparoscopic Cecectomy

    AAPC: CPC Promo
    What CPT code should I use for a laparoscopic cecectomy for the removal of a lesion/polyps? Our office had originally chosen 44110 until we noticed that it was for an open procedure.

  2. #2

    Default Me Too

    I was looking for the same thing. Hope some one out there can help.

    mgrubb

  3. #3

    Default

    After I read the op report for the one I needed for the lap cecectomy I used the 44204.

  4. #4

    Default

    Laparoscopic cecectomy would usually be a 44205, since the cecum connects the colon to the terminal ileum.
    C.Martin CPC-GENSG

  5. #5
    Join Date
    Apr 2007
    Location
    Johnson City
    Posts
    202

    Default

    I agree to using code 44205.

  6. #6

    Question Help!!

    PROCEDURE PERFORMED:
    1. Second look laparoscopy for ovarian cancer with collection of peritoneal
    cytology and removal of peritoneal implants and partial omentectomy.
    2. Laparoscopic cholecystectomy with intraoperative cholangiogram.
    3. Ileal colostomy with partial colectomy and resection of terminal ileum.

    SPECIMENS: Peritoneal implants. Peritoneal cytology. Gallbladder and its
    contents. Portion of terminal ileum. Portion of colon. Portion of omentum.

    INDICATIONS: The patient female who has history of ovarian
    cancer. She has undergone a radical hysterectomy with debulking, also a
    rectosigmoid resection and right hemicolectomy. She is here for reversal of
    colostomy, second look laparoscopy and cholecystectomy.

    DESCRIPTION: After informed consent was obtained, preoperative antibiotics, as
    well as subcutaneous heparin were administered within the hour of the
    procedure per protocol. . General endotracheal anesthetic was
    applied. Sequential compression devices were in place and functioning at time
    of induction. All pressure points were padded. A surgical time-out was
    performed per CMS guidelines. Her abdomen was prepped and draped in normal
    sterile fashion with the Op-Site covering her ileostomy.

    Initially a Veress needle was placed in the left upper quadrant. A 2 liter
    pneumoperitoneum was created and a 5 mm trocar was then inserted. Inspection
    of the abdomen showed an endoileostomy with a small hernia around the stoma,
    or a parastomal hernia and multiple implants throughout the abdomen. A 12 mm
    port and 2 right subcostal 5 mm ports were placed. Attention was initially
    directed towards collection of the specimens. Multiple small little nodules
    were noted throughout the stomach, the gastrohepatic ligament, as well as the
    bed of the gallbladder. The liver was otherwise unremarkable. There was
    evidence of a long mucus fistula with the hepatic flexure to the descending
    colon remaining intact. There was no pelvic lesions. As many implants as
    could be submitted were submitted, some for frozen and some for permanent and
    all the initial pathology returned negative for malignancy.

    The abdomen was filled with a liter of saline. There was a 5 minute dwell
    time and then the fluid was aspirated and sent for cytology. Upon completion
    of this the gallbladder was taken down in a dome down fashion until I got to
    the level of the cystic artery. It was doubly clipped and divided. The
    cystic duct was skeletonized. The duct itself was approximately 4 cm in
    length. It was cannulated with a cholangiogram catheter and under
    fluoroscopic interrogation there was sluggish flow through a mildly dilated
    common bile duct, but it eventually went into the duodenum without difficulty.
    The proximal biliary radicles were nondilated and there was no evidence of
    strictures or other lesions, or any filling defects within the common bile or
    common hepatic duct.

    With that in mind the cholangiogram catheters were removed, 2 clips were
    placed on the cystic duct stump. Bovie cautery was applied delicately to the
    end of the cystic duct to prevent postoperative leakage. The gallbladder bed
    was inspected and was hemostatic. The gallbladder was then placed in the
    left upper quadrant for later retrieval.

    This being done, the 12 mm port was closed at the fascial layer using #0
    Vicryl suture. I then cored out the ileostomy down to the level of the
    fascia. I mobilized the entire remaining right colon off of the duodenum and
    off Gerota's fascia taking care to prevent ureteral or vascular injury.
    After having satisfactory length, I then mobilized the entire ileostomy. I
    pulled the ileostomy out through the ileostomy incision and freshened up the
    end resecting approximately 3 mm of terminal ileum. I then pulled up the
    colon through the same incision and repeated the procedure. I removed the
    gallbladder through the incision where the ileostomy was, passed this off the
    field. I then created an end-to-end functional side-to-side anastomosis,
    placing GI pop-off silk sutures on the intermesenteric portions of the small
    bowel and the colon after ensuring there was no twist in the bowel.

    With this being done, I then opened the colon and small bowel, placed an
    endo-GIA 6 mm white load, advanced it, locked and fired it, creating a linear
    stapled ileocolostomy. Three GI pop-off silks were then used to temporarily
    close the common enterotomy and this was then closed with the stapling
    device. The mesenteric defect was likewise closed with a series of
    interrupted silk sutures. I then placed the entire anastomosis into the
    peritoneal cavity and closed the fascia with a looped #1 PDS suture tied upon
    itself. Having completed this, all wounds were copiously irrigated with
    saline and then Betadine. The fascia sutures at the 12 mm port site were
    closed. The skin incisions were again copiously irrigated with saline and
    Betadine. The ileostomy site was loosely reapproximated with a stapling
    device with Telfa placed as wicks and the laparoscopic sites were closed with
    4-0 Vicryl. Mastisol, Steri-Strips and planes were then applied. She was
    then awoken from anesthesia, extubated and transferred to the recovery room in
    stable condition, having tolerated the procedure quite nicely.
    Last edited by sabrinaecob@gmail.com; 04-12-2012 at 02:26 PM.

  7. #7
    Join Date
    Apr 2007
    Location
    Denver CO
    Posts
    77

    Red face

    Am I wrong or did this patient have a previous ileostomy and the surgeon now reversed it? I see a resection and anastomosis with closure of the skin level ileostomy site. If this is the case, I'd look at 44227. Other thoughts?

    Torilinne
    CPC, CGIC

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