# Need help!



## abishard (Apr 10, 2009)

I am needing help with a procedure.

FINDINGS:   Markedly enlarged spleen with distal pancreas intimately attached to the tip of the spleen, accessory spleen approximately 3 cm in size (resected).

DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in a supine position.  After the induction of general anesthesia, the patient was placed left side up 45 degrees.  The abdomen was prepped and draped in the usual sterile fashion.  An incision was made superior to the umbilicus and a Veress needle was inserted. Pneumoperitoneum was established.  Multiple trocars were inserted in the left upper quadrant.  These trocars included a 15-mm left lateral trocar.  

On laparoscopy, the spleen was markedly enlarged.  Retraction of the spleen was done and the short gastric vessels were taken down with the Enseal device.  The lateral attachments were taken down with the electrocautery.  The hilar vessels were dissected free.  At this point, the distal pancreas could not be disconnected from the tip of the spleen without potential injury of the capsule of the spleen.  Thus, the pancreas was encircled and an Endo-GIA was used to remove approximately 2 cm of the distal pancreas en bloc with the spleen.  The hilar vessels were then taken down with the Endo-GIA.  An Endobag was used to remove the spleen.  The spleen was morcellated and sent to pathology.

Inspection of the abdomen revealed an approximately 3 cm accessory spleen in the left upper quadrant.  This was resected using the Ace Harmonic.  The abdomen was irrigated.  A Jackson-Pratt drain was placed at the transection site of the pancreas.  The trocars were removed. 

The fascia was closed with 0 Vicryl.  Skin was closed with 4-0 Biosyn.  The patient tolerated the procedure well.

I know to code 38120 for the laparoscopic splenectomy but am not sure about the resection of the accessory spleen and the distal pancreatectomy (all done laparoscopically).

Thank you!


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## tomoreno (Apr 10, 2009)

The 38120 looks to be a complex resection due to an anomaly.  Have you considered modifying the complex procedure with -22?


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## skpartiss (Dec 21, 2009)

Should be 48999


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