# Removal of foreign body in abdomen



## mgord (May 28, 2014)

DX:  Foreign body in the abdomen (CT showed a clip directly behind the umbilicus right at the peritoneal surface)

Procedure:  Exploratory laparotomy with removal of foreign body. 

The patient was placed supine and underwent general endotracheal anesthesia. The periumbilical area was prepped and draped in normal sterile fashion. An incision was made through the infraumbilical scar. The subcutaneous tissue was dissected with cautery down to the fascia. We then very carefully incised the fascia right up to the base of the umbilicus. In doing that, we identified the clip just on the peritoneal side of the fascia. That was grasped and extracted and sent for pathological evaluation. The wound was irrigated and hemostasis was assured. The fascia was then closed with multiple figure-of-eight 0 Vicryl sutures. The wound was again irrigated. The wound was then injected with local anesthetic and closed with Monocryl suture. Steri-strips and sterile dressings were applied. The patient was awakened and returned to the recovery room in stable condition. She tolerated the procedure well without evidence of complications. All counts were correct. 


My first issue is with the diagnosis. The doctor and the hospital coded this as 959.9. I was thinking 729.6 and V90.10 since this clip was left intentionally and maybe 22999 (although I hate to go with unlisted code). The hospital coder is using 49402 because he said the clip was on the peritoneal side of the fascia. I see her point but I'm not sure he entered the abdominal cavity. 

Thanks for any assistance that you could offer. 
MB


----------



## cynthiabrown (Jun 3, 2014)

look 20525


----------

