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Low anterior resection with reversal of colostomy. Right salpingo-oophorectomy.

  1. Default Low anterior resection with reversal of colostomy. Right salpingo-oophorectomy.
    Medical Coding Books
    I just don't want to miss anything on this one. Any input would be greatly appreciated.
    Thanks.


    OPERATION PERFORMED
    Low anterior resection with reversal of colostomy. Right salpingo-oophorectomy.

    DESCRIPTION OF PROCEDURE
    The patient was brought to the operating room and after attainment of sufficient general anesthesia, she was pretreated with antibiotics and prepped and draped in the usual sterile fashion. I made a 10 mm incision in the right upper quadrant and another one in the right hypogastrium. Introduced a 5 mm port in both sites and insufflated. Took down the adhesions along the midline and then mobilized the colostomy site in the left lower quadrant. Once we had mobilized the site, we opened up the patient's wound. The patient's wound had scarred down before and she had asked if I could revise it, so I just made this incision a bit larger than I normally would and then took down all the scar that was beneath it and then made our exposure. I took down more adhesions down in the pelvis and we saw that the right ovary and tube were plastered onto the repair of colon the distal rectal stump and we were trying to take that off, got into some bleeding and thought that it would just be easier just to remove that tube and ovary on that side. We placed clamps around the ovarian vessels, ligated them off and removed the tube and ovary on that side. Once that was done, we could see that the colon was really pretty adhesed in this area. We elected just to mobilize it, came down the peritoneal reflection, mobilized the colon, firing a contour device distally and removing the remains of the sigmoid colon, leaving us just with the rectal stump in the retroperitoneum. We then brought down the colostomy site which we had sized out to 28 mm, placed an anvil into the remains of the sigmoid and descending colon, tied that down, sized out the rectum with sizers and then went up with the CEEA plus, brought the sharpened obturator through the staple line and removed the obturator, connected the anvil to the device, tightened it down, fired it, making a 28 mm anastomosis. We then air tested the anastomosis and found that we had good insufflation and no air leak. A 10 mm Jackson-Pratt was placed in the pelvis. We irrigated copiously throughout the case using antibiotics containing solution, using probably about 2 to 3 L in the course of the procedure. We then closed the anterior abdominal wall with #1 double stranded PDS followed by irrigation. We also closed the colostomy site with figure-of-8 sutures of 0 Prolene. We closed the colostomy site over a Penrose drain, then used 3-0 Vicryl, irrigated again, close the skin leaving the Penrose to drain and then at the abdominal wall site, we irrigated again and then used skin staples. The patient tolerated the procedure quite well.

  2. Default
    Just hoping for some other opinions on this one. One of the coders has this coded as 44626, but I feel that is not the total picture. I don't want to miss anything. Any thoughts?

    Thanks

  3. #3
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by ksb0211 View Post
    I just don't want to miss anything on this one. Any input would be greatly appreciated.
    Thanks.


    OPERATION PERFORMED
    Low anterior resection with reversal of colostomy. Right salpingo-oophorectomy.

    DESCRIPTION OF PROCEDURE
    The patient was brought to the operating room and after attainment of sufficient general anesthesia, she was pretreated with antibiotics and prepped and draped in the usual sterile fashion. I made a 10 mm incision in the right upper quadrant and another one in the right hypogastrium. Introduced a 5 mm port in both sites and insufflated. Took down the adhesions along the midline and then mobilized the colostomy site in the left lower quadrant. Once we had mobilized the site, we opened up the patient's wound. The patient's wound had scarred down before and she had asked if I could revise it, so I just made this incision a bit larger than I normally would and then took down all the scar that was beneath it and then made our exposure. I took down more adhesions down in the pelvis and we saw that the right ovary and tube were plastered onto the repair of colon the distal rectal stump and we were trying to take that off, got into some bleeding and thought that it would just be easier just to remove that tube and ovary on that side. We placed clamps around the ovarian vessels, ligated them off and removed the tube and ovary on that side. Once that was done, we could see that the colon was really pretty adhesed in this area. We elected just to mobilize it, came down the peritoneal reflection, mobilized the colon, firing a contour device distally and removing the remains of the sigmoid colon, leaving us just with the rectal stump in the retroperitoneum. We then brought down the colostomy site which we had sized out to 28 mm, placed an anvil into the remains of the sigmoid and descending colon, tied that down, sized out the rectum with sizers and then went up with the CEEA plus, brought the sharpened obturator through the staple line and removed the obturator, connected the anvil to the device, tightened it down, fired it, making a 28 mm anastomosis. We then air tested the anastomosis and found that we had good insufflation and no air leak. A 10 mm Jackson-Pratt was placed in the pelvis. We irrigated copiously throughout the case using antibiotics containing solution, using probably about 2 to 3 L in the course of the procedure. We then closed the anterior abdominal wall with #1 double stranded PDS followed by irrigation. We also closed the colostomy site with figure-of-8 sutures of 0 Prolene. We closed the colostomy site over a Penrose drain, then used 3-0 Vicryl, irrigated again, close the skin leaving the Penrose to drain and then at the abdominal wall site, we irrigated again and then used skin staples. The patient tolerated the procedure quite well.
    58720 for the Rt Salpingo-Oophorectomy
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. #4
    Default
    I agree with Arlene as well!

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