# excision abdominal tumors



## ksrkelly7 (Oct 13, 2015)

Hi there.  I would like to verify some codes.  Doc wants to bill CPT 22901, 22903 and 49568 for the OP report below. I think the coding should be as follows:

22901-22 (for the additional work of 2nd tumor removal - same incision)
15777 (implant of biologic, trunk, for Acell)

Any opinions on this?



Indication for Surgery 
Painful abdominal wall masses

Preoperative Diagnosis 
Abdominal wall masses probable endometriomas

Postoperative Diagnosis 
Endometriomas of the abdominal wall

Operation 
Excision of endometriomas from the abdominal wall and subcutaneous tissues with placement of Acell graft

Findings 
There was a 3 cm fibrotic mass in the subcutaneous tissues of the left groin area.  This did not seem to have invaded the rectus sheath.  There was a 4 x 5 cm fibrotic mass in the lower midline just below the umbilicus.  This also appeared to be an endometrioma.  This had a little desmoplastic reaction.  A portion of the linea alba and rectus muscles were very adherent to the mass and had some desmoplastic reaction.  A 7 x 10 cm Acell graft was placed the retro-rectus space.

Specimen(s) 
Abdominal wall masses

Complications 
None

Technique 
After pre-operative evaluation and informed consent was obtained, the patient was brought to the operating room.   She was placed under suitable general anesthesia with endotracheal intubation.  Sequential compression devices were applied.  IV antibiotics were administered.  A surgical pause was performed to confirm the patient identification and correct surgical procedure.   The patient was then prepared and 3 minutes of drying time for the prep was allowed prior to draping the patient in the usual sterile fashion.

 The tissues surrounding one of her previous cesarean section scars were infiltrated with 0.5% Marcaine with epinephrine. Her old scar was excised and the subcutaneous tissues were divided.  The subcutaneous mass in the left groin area was palpated and then excised using the electrocautery device.  This was removed intact.  The subcutaneous tissues were mobilized off the fascia cephalad and the mass was palpable just below the linea alba in the midline of the abdomen.  The linea alba and the mass as well as a portion of the the rectus muscles it had been attached to were excised using the electrocautery device.    The retro-rectus space was further developed using sharp and blunt dissection.  A 7 x 10 cm Acell graft was placed into the space.  This was attached to the anterior abdominal wall circumferentially using 0-PDS interrupted sutures.    Excellent hemostasis was obtained using the electrocautery device.   The wound was copiously irrigated  with saline solution.  The subcutaneous tissues were approximated using 3-0 Vicryl suture.  The skin was closed using 4-0 Monocryl suture.  Dermabond was applied.  A Coverderm dressing was applied.  The patient was awakened out of anesthesia, extubated and transported to the recovery room in stable condition.   Classification of wound is clean-refined.


Thanks for your help!!

Kelly


----------

