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996.73 vs 629.32

  1. Default 996.73 vs 629.32
    Medical Coding Books
    Which ICD-9 code would you use? 996.73 vs 629.32. Do I have enough documentation for exposure of mesh into vagina or through vaginal wall?

    PREOPERATIVE DIAGNOSIS:
    Chronic severe pelvic pain, status post Prolift mesh insertion with secondary
    scarring and mesh retraction.

    POSTOPERATIVE DIAGNOSIS:
    Chronic severe pelvic pain, status post Prolift mesh insertion with secondary
    scarring and mesh retraction.

    OPERATION PERFORMED:
    Transvaginal lysis of Prolift mesh arms and cystoscopy.

    OPERATIVE PROCEDURE:
    After the induction of general anesthesia, the patient was placed in a full
    dorsolithotomy position and was prepped and draped in the usual sterile manner.
    Visual examination under anesthesia with retraction revealed no mesh erosions.
    Palpation revealed a very dense contracted scar band in the apical left vaginal
    wall and some scar band in the left lateral vaginal sulcus behind the pubic
    symphysis. There were 2 less indurated bands in the same position on the right
    side. The left apical band appeared to be approximately 2 to 3 cm distal to
    the ischial spine and in the levator plate and not the obturator internus
    muscle. That band was grasped with a long Allis clamp and a vertical incision
    in the vaginal wall made. At that point, the Foley catheter was removed and
    the bladder was inspected with a 70-degree cystoscope. Panendoscopy revealed
    no mucosal abnormalities and no mesh in the bladder. Each ureteral orifice was
    clearly identified. There were no urethral abnormalities noted. With traction
    on the mesh arm, there was some downward deviation of the ureter but no clear
    impingement on the ureter. There was clear efflux of urine from the left
    ureteral orifice. The Foley catheter was then replaced and with blunt
    dissection, the mesh arm was dissected down to the left pelvic sidewall and the
    levator muscle. With direct tension on the mesh arm, the arm was cut with
    heavy scissors. There was immediate release of the tension on the lateral
    sidewall. There were 2 separate scar bands which were clearly isolated and
    lysed. There was then blunt dissection carried up behind the posterior surface
    of the inferior pubic ramus and the distal arm of the anterior medial Prolift
    mesh was isolated and grasped with the Allis clamp. The Foley catheter was
    withdrawn and cystoscopy was then performed. There appeared to be no
    impingement on the ureter with traction on the anterior medial arm. The Foley
    catheter was then replaced and the bladder drained. There was direct
    visualization of the left anterior medial arm and this was directly lysed. The
    left pelvic sidewall was then copiously irrigated and found to be hemostatic.
    The vaginal incision was then closed with a running 2-0 Vicryl in a continuous
    fashion. The right anterior medial band was then grasped transvaginally and a
    small vertical incision made over the band in the pelvic sidewall of the
    vagina. With blunt and sharp dissection, the right anterior medial band could
    be clearly delineated and grasped. The Foley catheter was removed again and
    the bladder inspected. There was no deviation of the ureter on the right side
    with some deviation of the right lateral sidewall but no impingement or no
    entry into the bladder. With the Foley catheter replaced, this band was
    directly cut and clear mesh was seen in the scar band. The right posterior
    lateral arm was then clearly identified at the level of the ischial spine and
    was grasped with an Allis clamp and cut directly. There was adequate
    hemostasis at this time after irrigation and the side wall was closed with a
    running 2-0 Vicryl in a continuous fashion. At that point, the vagina was
    packed. The patient was given an intravenous dose of 5 mg of Lasix with an
    ampule of indigo carmine. The Foley catheter was withdrawn and the bladder
    inspected. There was clear efflux of blue stained urine from each ureteral
    orifice. The Foley catheter was replaced. All sponge, needle and instrument
    counts were correct. The patient was awakened from general anesthesia and
    returned to the recovery room in good condition.

    ANESTHESIA:
    General.

  2. #2
    Location
    Salt Lake City
    Posts
    841
    Default
    996.73 is for a renal dialysis device.
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    Location
    Salt Lake City
    Posts
    841
    Default
    did you mean to say 996.76? That is what I would use.
    Jenifer McPolin CPC, CPMA, RCC

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