# abdominal washout, maturation of the colostomy, temporary abd closure w/ Abthera VAC



## ttate (May 23, 2012)

yesterday, pt underwent lap sig-colectomy for diverticulitis w/ mult abd abscesses.  Surgeon did not close due to significant edema of the bowel.  They placed Abthera wound VAC.  Also, they did not mature the colostomy.  

Today, pt is returned to operating room for abd washout, maturation of the colostomy - still not able to close the wound due to swelling of the bowel.

procedure:  wound VAC system removed.  abd cavity exposed, no residual abscess formations.  The area where they had stapled the end of the descending colon was exposed.  At the stapled end, there was a short area about an inch long that had ischemic changes - surgeon felt it needed to be resected and sent to pathology.  Then proceded to further mobilize the descending colon by dividing the lateral peritoneal attachment in order to obtain adequate length to create colostomy.  Proceeded to do a thorough washout of the abd cavity using normal saline.  Two shirly sump drains in penrose drains were placed (one in the Rt side in RLQ where initial abscess was located and another was placed in the LT side and advanced down the pelvis where another abscess was located).  Then Dr selected the site for the colostomy in Lt side of abd wall.  Disk of skin excised.  Ant rectus sheath dividied in crutiate manner. Rectus muscle split, exposing posterior sheath which was also divided in cruciate manner and site was enlarged.  Stapled end of descending colon brought out to be matured as a colostomy.  After thorough irrigation, abd wound was covered and Dr proceeded to mature the colostomy.  Stapled end was resected and the cut edge of the descending colon was sutured to skin.  Attempted to close the main wound but not possible due to swelling of the bowel.  Reapplied the Abthera wound VAC after trimming.  Followed by foam then adhesive.  suction tubing was applied and Abthera was functioning properly.  Colostomy site was then exposed, applied a colostomy wafer and bag over stoma.

Coding Question:  we are in the global period of the sigmoid colectomy... can we bill 44143 with mods 78 and 52?  Or is that inappropriate?  Should I use a revision code?  Not sure if I can bill for the peritoneal lavage - although there is not a CCI edit.

Any help would be greatly appreciated.


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