# Appendectomy, Enterolysis, Salpingectomy and adhesiolysis



## preserene (Oct 1, 2010)

I would like to know for sure about the coding rules of appendectomy, enterolysis, appendectomy and enterolysis, salpingectomy, adhesiolysis and appendectomy  and viceversa and thier combination of procedures, as and when each had their own part as the primary procedure.  Here we go:

Case 1:Surgeon  posted the patient for surgery- 'Appendectomy'. He opened the abdomen  and found it difficult to excise appendix due to lot of intestinal adhesions. he felt it is not possible to do appendectomy without releasing the  intestinal loops safely from the adhesion and so he did release and then proceeded with appendectomy, completed and closed the abdomen after complete hemostasis and maknig sure the loops of intestines are intact.
code the scenerio.

case 2: Patient had acute intestinal obstruction  and the Surgeon diagnosed lots of intestinal adhesion and did adhesiolysis ( enterolysis) and found it mandatory to release the appendix also from the other intestinal  loops ; he did and found the appendix could not be released intact andso he proceeded on to appendectomy. He found other intestinal loops are well secured without perforation and he did a peritoneal  washing and irrigation with metronidazole and saline solution and closed the abdomen after complete hemostasis. Code the procedures untertaken by the surgeon 

case 3: the surgeon does the appendectomy  during enterolysis procedure by an open abdominal approach, just as a prophylactic  as  a measure to avoid future adhesion/ and a repeat procedure of yet another adhesiolysis. code th procedures.

Case4:  An obstetrician does a laparoscopic salpingectomy for a ruptured ectopic on the right side. During the procedure she finds the appendix bieng adherent to the tube and she did adhesiolysis, proceeded with appendectomy,  though the appendix did not seem to be swollen or inflammed.But she also found a small loop of intestine (a portion of cecum) adherent to the tube and so she released this loop also. Lots of big Blood clots (amounting to two liters of blood) from the abdominal cavity removed and the abdomen closed in layers after securing comlpete hemostasis. Code the whole scenerio of operative procedures. 


Thank you for your time and release!


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