# Urology Case-need help



## mbort (Jun 25, 2008)

I'm trying to avoid using an unlisted procedure code for the lap uterine suspension if at all possible so figured I would put this case out for others to help me with 

PROCEDURES PERFORMED:               1.         Operative laparoscopy.

                                                                        2.         Uplift procedure.

                                                                        3.         Lysis of adhesions.





DESCRIPTION OF PROCEDURE:         After successful induction of anesthesia, the patient was in the dorsal lithotomy position and prepped and draped in the usual fashion.  Bimanual exam was performed confirming the retroverted uterus.  The bladder was catheterized and intrauterine manipulator was placed in the uterus.  Attention was turned to the abdomen where after changing gloves, upward tension was accomplished on the abdominal wall.  A Veress needle was inserted through the superior pole of the umbilicus.  Free air was aspirated for and CO2 was infused to a pressure to not exceed 4 mmHg.  After getting adequate pneumoperitoneum, an infraumbilical incision was made and a trocar was introduced.  It should be noted that after the Veress needle was placed, saline drop test and free air was checked for.  Further, the trocar was placed with upward tension on the abdominal wall through the infraumbilical incision and upon entering the peritoneal cavity, the scope was placed and exploration was done confirming normal anatomy below and no evidence of any injury.  At this time, attention was turned to the pelvic cavity where there was noted to be on the uterosacral 
ligament, few spots of endometriosis and there were scar tissue between the left ovary and the intestine.  At the conclusion of the case, this piece of scar tissue through avascular portion was cut to lyse the scar tissue and adhesion.  At this time, a nick was made under direct vision inferior and left from the primary site, which was just above superior and lateral to the insertion of the round ligament on the left of the inguinal canal and then under direct vision, the uplift kit was utilized.  The needle was brought down through the round ligament and exited approximately 2 cm from the insertion of the uterus. 

The piece of Prolene suture was left here and then fascial bridge was created and the needle was then brought down again on the contralateral side of the round ligament and brought out, grasped the suture, and this was brought up and tagged outside.  Good support was noted, as this was pulled up.  The uterus was anteverted with the stitch alone. Attention was then turned to the right side and in the same fashion, a nick was made.  The suture was placed to the round ligament and facial bridge created and this was brought up as well.  When both sides were completed, each side was then tied with six ties onto the fascia and sutures were cut.  The uterus was anteverted.  The adhesions were lysed as stated and with hemostasis being noted, the procedure was now to be concluded.  The instruments were removed and CO2 was allowed to escape.  The trocar was removed.  All incisions were closed with Dermabond.  Instruments were removed from the vagina.  Exam confirmed anteverted uterus and the patient went to the recovery room in stable condition with all counts being correct.

Thanks
Mary


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## maggiedodd (Jul 25, 2008)

*op note for mary*

tricky

i to dont like unlisted codes they should come up with one for everything

there are a couple of options i will give you codes and you can look at them and deceide

58400 58410 of course these are the open

58559 ??
58578 is the unlisted 

58660 could be an option 

good luck


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## codersumit (Jul 30, 2008)

Mary, my friend, the only option we have in this case is reporting: 58578 & 58660
Although, 58660 is a 'separate px' and is quite inclusive to the main surgical px, but we dont have any option and as far as we have separate dx for pelvic adhesions, i think we should be okay to justify, if audited, etc.
For suspension, there is no other option and of course we would not want to code it to open


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