# Mini-Laparotomy w/LOA and excision of poriton of the omentum



## NVobgynCoder (Oct 30, 2012)

I need help coding this Op report:

Preoperative DX: Right lower quadrant mass, possible hernia

Postoperative DX: Omental herniation right lower quadrant

Operation: Mini laparotomy with lysis of adhesions and excision of portion of the omentum

Description of Procedure: Under satisfactory general anesthesa, patient was placed in the supine position. Abdomen prepped and draped sterile field as well as the vulva and perineum. Direction was first paid to the abdominal wall and in an area of an old incision, an incision was started and extended approx 1 inch lateral to the old incision, total length of approx 3 inches. The thickened fatty tissues were grasped and dissected down until the fascia which was grasped and held and then the mass elevated. The peritoneum was entered and was noted to be a segment of omentum extending up through the incision. This was dissected free of any adhesions and then clamps placed across a portion of omentum, anthis was excised and removed after being doubly ligated. No abnormalities were noted through the incision. Peritoneum was then closed using a 2-0 Vicryl suture. The fascia was closed using #1 Vicryl suture. Subcutaneous tissues closed using 2-0 Vicryl suture and 4-0 subcuticular Dexon suture on the skin. 

According to the Pathology report, the specimen was adipose tissue measuring approximately 8x4.5x0.1 cm. Their final diagnosis was benign fibroadipose tissue; 211.8

I know there isn't a code for a "Mini" laparotomy, so I was looking at the laparotomy codes and the best one I found was 49255 for an omentectomy. Would that be correct? 

Any feedback would be helpful!  

Thanks!
Claudia


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## preserene (Nov 1, 2012)

Minilaparotomy, surgery done by OBGYN and the final pathology report as fatty tissues from the omental, I would go more in favor of 58662 excision of pelvic viscera(be it omental, peritoneal or any viseral) than for 49255;  for the adhesiolysis, I would like to append modifier -22.
the diagnosis would also be for incisional hernia

can you give more info about the place of previous scar or the name of the previous surgery done


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## NVobgynCoder (Nov 1, 2012)

I will look over her records tomorrow at work to see what the previous surgery was. Whatever the previous surgery was, it has to be older because this is the first surgery we have done on this pt. Thanks for your input, appreciate it!


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