Could use some help please.
How would I code procedure
2: Left fulguration and excision of endometriosis
3: Excision of left paratubal cyst
4: Hysterectomy, dilatation and curettage.
Initially hysteroscopy was carried out with single tooth tenaculum used to grasp the anterior lip of the cervix. The cervix was dilated to 4 mm. A 4mm hysteroscopy was place using ringers of lactate for a pressure distention medium through a very small cavity and really was difficult to go up high in the cavity. We did do curetting of this tissue as she complained of some menorrhagia, but certainly she did not have a large enough cavity to do an ablation Once this was completed and tissure was obtained, we than placed a Cohen Eder cannula. Gloves were changed.
Umbilicus was infiltrated. A vertical 5 mm incision in the umbilicus. Hemostat dissection through the umbilicus to the peritoneum. A 5 mm sheath was then place under direct vision, CO2 insufflation was carried out. A 5 mm laparoscope was then inserted to make sure we were intraperitoneal with no vascular or visceral damage. The patient was placed in the Trendelenburg position. A 5mm bladeless trocar was then placed under direct vision 3 fingerbreadths above the pubis in the midline. Prior to this 3 ml of Macranine 0.5% with epinephrine was infiltrated. With the aspiration irrigation cannual, we were able to visualize a normal appearing uterus. She had a previous tubal ligation. She had a left paratubal cyst on the left tube that was excised and removed. She had black endometriosis on the left pelvic sidewall which was coagulated and excised and suctioned free with the irrigator. The right ovary was normal. She had previous right partubal ligation as well. At the cul-de-sac, it was clean, no endometriosis. The cecum was somewhat retroverted. She had a massive amount of adhesions around the old gallbladder. The gas was removed.
Thank you for your help!