# Repair of Cystotomy



## KoBee (Feb 20, 2019)

New to this specialty... Need help please

I have codes 58571/51999

Can't find a code for Repair of cystotomy




PREOPERATIVE DIAGNOSIS:
Family history and genetic predisposition to ovarian endometrial cancer.

POSTOPERATIVE DIAGNOSIS:
Family history and genetic predisposition to ovarian endometrial cancer.

PROCEDURE:
1. Robotic laparoscopic hysterectomy, bilateral salpingo-oophorectomy.
*2. Repair of cystotomy.*
3. Diagnostic cystoscopy.

ANESTHESIOLOGIST:
Dr. xxxxx

ANESTHESIA:
General.

FINDINGS:
The patient had normal uterus, tubes, ovaries and pelvis.  The cystotomy was
done on the dome of the bladder through dissection of lower uterine segments
and the cervicovaginal junction.  This was identified immediately and repaired.
 There were no other injuries.  There was no bowel injury or ureter injury at
the end of the case.  Instillation of saline was done into the bladder at
approximately 500 cc with no bladder leak noticed laparoscopically.  Bilateral
jets from the ureteral orifices were present. 

BLOOD LOSS:
50 mL.

DRAINS AND PACKING:
Foley catheter.

IV FLUIDS:



A 1000 cc of crystalloid.

URINE OUTPUT:
200 cc of amber urine.

COMPLICATIONS:
Cystotomy.

SPECIMENS:
Uterus with cervix and bilateral uterine tubes and ovaries.

DISPOSITION:
Postanesthesia care unit.

POSTOP CONDITION:
Stable.

DESCRIPTION OF PROCEDURE:
After reading and signed the consent, the patient was brought to the operating
room, where general anesthesia was induced.  She was placed in the dorsal
lithotomy position.  The abdomen, perineum, and vagina were prepped and draped
in usual sterile fashion.  Time-out was called to confirm correct patient
identity and planned procedure.  A weighted speculum was inserted into the
vagina after a Foley catheter was placed.  The anterior lip of the cervix was
grasped with a single-tooth tenaculum.  The uterus was sounded to 8 cm.  Stay
sutures were placed at 3 and 9 o'clock and a medium VCare uterine manipulator
was sutured into place.  All instruments removed from the vagina.  Attention
was paid to the abdomen where a supraumbilical incision was made with a
scalpel, carried down to the fascia which was grasped similarly with Kocher
clamps.  This was incised and using blunt entry, the peritoneal cavity was
entered.  The Hasson trocar was placed without difficulty under direct
visualization, the right and left 8 mm port and an AirSeal port to the left
were placed with no injuries.  The robot was docked.  The right arm was curved
monopolar scissors and the left arm was the bipolar Marilyn.  In a sequential
fashion and then bilaterally, the infundibulopelvic ligaments were come across
just under the ovary with no bleeding from this pedicle.  The round ligament
was taken bilaterally in the anterior leaf and the posterior leaf of the broad
ligament were separated.  The bulge was seen and the tissue was cleared from
the anterior surface of the uterus to push the bladder cephalad position but it
was clear that there was approximately 1 cm entry into the bladder.  This was
then fixed at this point with 3 layers of 2-0 Vicryl suture with no
complications thereafter.  The rest procedure could be completed.  The uterine
artery was taken bilaterally when both the anterior and posterior aspects of
the cuff could be seen and following this and the tissue was cleared, colpotomy
was done circumferentially with no difficulties.  The cuff was closed with a
V-Loc suture with excellent closure.  All pedicles were evaluated.  There was
no bleeding as insufflation was released.  Attention was then paid to
cystoscopy.  The bladder was filled and the pneumoperitoneum was reestablished
only with left gas and the camera placement showed the repair was watertight.
The bladder distended nicely at cystoscopy and there was almost immediately
jets that were stained with fluorescein yellow as given by Anesthesia.
Everything else was removed from the bladder and the diagnostic cystoscope with
saline distention media was removed.  The Foley catheter was replaced.  The
fascia of the umbilical incision was closed with 0 Vicryl and then the skin
incisions were closed with a 4-0 Monocryl in a running subcuticular fashion.
The patient tolerated the procedure well.  There were no complications. 

Sponge, lap, needle counts were correct x3.  The patient received Cefotetan 2 g
prior to initial incision.


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## csperoni (Feb 21, 2019)

*Can't bill to fix your own injury*

From what I see, the physician created the bladder wound during the surgery.  It's not all that uncommon, particularly if there are dense adhesions, etc.  The surgeon is not able to bill for a repair of an injury he/she created.  This repair is not billable for this case.  

IF another physician is called in to repair a wound created by another physician, this would be billable.  Repair of a bladder wound is called cystorrhaphy.  There is no code for it laparoscopically, and you use 51999.  I would compare it to and value as 51860 which is an open cystorrhaphy.


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## KoBee (Feb 21, 2019)

Thank you so much! makes total sense


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