Lysis of adhesions, further drainage of pelvic abscess & repair of serosal tears
My doc was called in intraoperatively and performed extensive lysis of adhesions, drain pelvic abscess & repair of four serosal tears. Here is the op -
Patient was taken to surgery by another physician for a cuff abcess in the pelvis. In taking down adhesions, the doc was concerned about the bowel and asked for my advice. There were numerous dense adhesions in the pelvis. After about an hour and a half of work, I was able to chisel the small bowel out of the pelvis laparoscopically, taking down adhesions. There was an abscess of the vaginal cuff and there was probably about 2 1/2 feet of small intestine which was intermittently involved with this abscess. All of these loops were taken down and were freed. After the completion of this the patient was noted to have four small serosal tears caused by the primary surgeon. Each of these four tears was repaired with intracorporeal suturing, the first suture was the longest and this was about 3 cm. The second 2 c tear was then repaired. A third 1.5 cm tear was repaired. The remainder of the examination did not reveal any evidence of serosal tears or problems in the bowel. The bowel was run from proximal to distal and through the affected areas. There was no evidence of bowel obstruction and the loops of bowel were all freed up. After this was completed, the pelvis was washed out copiously. The rectum appeared to be intact as did the other pelvic structures. The vaginal cuff was easily identified and the infection had been removed. After washing out the pelvis the trocars were removed under direct vision.
My doc wants me to charge for lysis of adhesions, drainage of pelvic abscess and repair of the the four serosal tears. If so, what do I charge for the drainage of the abscess and repair of the tears????
I think for the drainage of pelvic abcess you would use 57010 it is for colpotomy with exploration with drainage of pelvic abcess-- colpotomy (an incision into the wall of the vagina with exporation with drainage of pelvic abcess).
I'm not sure about what TO code, but I'm certain 57010 is not correct. 57010 is performed via speculum through the vaginal wall. Seems to me this was done laparoscopically through abdominal incisions.
I'm wondering if your surgeon should only code the extensive enterolysis CPT 44180. I don't see that he describes draining the abscess at all.
As for repairing the 4 tears ... Hmmm ... usually if you caused the problem you fix it without billing for it. I realize that the primary surgeon caused the tears, not the surgeon you are coding for ... but, still.
Hope that helps.
F Tessa Bartels, CPC, CEMC
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