# 58952?



## nabernhardt (Mar 7, 2012)

I had come up with cpt code 58952 for this procedure.  But now second guessing myself.  Wanting second opinions please. Thanks

OPERATION: Laparotomy with bilateral salpingo oophorectomy, omentectomy, excision of
multiple tumor serosal metastatic lesions.
PROCEDURE: The abdomen was entered through a vertical midline incision in the
lower portion of the abdomen. Upon entering the abdomen, some adhesions to the anterior
abdominal wall were encountered and taken down. A palpable peritoneal metastasis was
identified in the right side of the anterior abdominal wall and this was excised. The pelvis was inspected and fluid was identified and this was suctioned and collected in a Lukens tube and sent for cytological evaluation. There was obvious metastatic disease to the serosa of the pelvic floor. Both right and left ovaries were identified and were resected. The ovarian pedicles were isolated, clamped, cut and ligated with Vicryl suture. Cautery was used for additional dissection until the ovary and any remnant of the fallopian tube could be removed. The patient had a previous hysterectomy. In the pelvic floor, however, multiple tumor studdings were identified in this area and were on the rectal vault, peritoneal surface and lateral peritoneal wall. Several of the larger ones of these were excised. The smaller ones were cauterized or treated with the harmonic scalpel in an attempt to destroy as much of the tumor as possible. This, however, was not completely resectable short of a pelvic exoneration. The omentum was identified and the majority of the metastatic process did seem to be residual in the omentum and the transverse colon was identified and the omentum was dissected free as close as possible to the transverse colon, removing the bulk of the tumor. Small tumor nodules did remain on the colon itself and these were either treated locally or left intact. There was a bulk of tumor approximately 5 cm in diameter and maybe 1 cm thick in the mesentery of the hepatic flexure and after considerations of resection of this area were entertained, it was elected to leave this alone in view of the fact that the remaining tumor could not be satisfactorily resected for complete debulking. The serosa of the small bowel also contained numerous small areas, which were excised initially and then the remaining serosal attachments were reinforced with interrupted sutures of 4-0 silk in an attempt to eliminate the potential for perforation where these tumor nodules had been decided. This was all during the process of a decision on whether or not a complete debulking could be performed. Ultimately it was decided that this was not going to be a successful debulking procedure and therefore the procedure was completed with irrigation of the abdominal cavity and closure of the incision with running number 1 Prolene suture. The subcutaneous tissue was irrigated and the skin was closed with skin clips.


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## nabernhardt (Mar 10, 2012)

anyone have a suggestion please?
thanks


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## nabernhardt (Mar 14, 2012)

ok just trying again here.  Really wanting to get anothers opinion if possible.
now rethinking this and maybe should use 58950 since the dr was not able to successfully debulk the bulk of the tumor.  what was removed was through the omentectomy. though the dr did excise and destroy some of the tumors. I dont think its enough though to use 58952?  
trying to walk myself through this. thanks


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