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Laparotomy, Jejunum, Splenic Flexure, Bladder

  1. #1
    Default Laparotomy, Jejunum, Splenic Flexure, Bladder
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    Our billing office is in a dilema on how to code this procedure -- we are coming up with two set of billing codes. We need to find out which set is correct for this procedure:

    The jedjunum was then followed starting at the ligament of Treitz. At about 15 cm from the ligament of Treitz, perforation was seen in the jejunum. Approximately 10 cm at this point, 2 more perforation was seen in the jejunum. The rest of the jejunum and ileum was inspected. There were no injures. An area just proximal to the first perforation was identified. Small opening was made in the sesentery. A GIA stapler was then brought across the jejunum and fired dividing the jejunum. Area just distal to the third perforation was identified. An opening was made in mesenter. GIA was fired dividing the jejunum. The jejunum was then removed from the mesentery using the LigaSure. Any bleeders seen in the mesentery were controlled with LigaSure. The 2 limbs of the jejunum were then reapproximated side by sided. Small opening were made in the 2 limbs of the jejunum. The GIA stapler was then introduced and fired creating a side to side anastomosis. It was inspected and seen that the anastomosis was openeed. TA-60 was then used to close the opening in the jejunum.

    The cecum, ascending colon, and transverse coleon were inspected. At the splenic flexure, another perforation was identified. The descending colon, sigmoid colon, and rectum were inspected. There were no injuries in this area. The lienocolic ligament was identified and serially divided with electrocautery. This was done until the splenic flexure could be brought down. An area just proximal to the perforation was identified. An opening was maded in mesenteric and the GIA stapler was fired dividing the colon. An appropriate section distal to the splenic flexure was identified. The LigaSure was then used to divide the colon off the mesentery and GIA was used to divided the colon. Small opening was made. A GIA stapler was introduced and fired creating a side to side anastomosis. The opening in the colon was then closed with TA-60.

    At this point, it was seen that there was a hole in the bladder. This was approximately 2cm in size. Inside of the bladder was irrigated. The balloon from the Foley can be identified. Indigo crmine at this point was then seen coming into the bladder. None was coming from the urter. The sides of the bladder hole was then approximated with Allis clamps. The closure was performed with a running suture of 2-0 Chromic. This was done to approximate mucosa to mucosa. It was then seen that the closure was watertight.

    Here are the set of codes: 44120, 44121, 51860
    44140, 44139, 51860
    Which one is correct?

  2. #2
    44120, 44140, 44139 and 58160 are the correct codes. 44121 doesn't apply since only one small bowel resection was done

  3. #3
    Thanks for helping us out!!!

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