# Coding Question - stating procedure



## drhoads (Aug 16, 2012)

I received an op note stating procedure performed:  Exploratory laparotomy, control of hemorrhage, repair of anastomotic breakdown at coloproctostomy, appendectomy, loop ileostomy, evacuation of hemoperitoneum and sigmoidoscopy.  Could anyone please assist me in coding this report.  Thank you.


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## syllingk (Aug 16, 2012)

Yes. If you post the note.


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## drhoads (Aug 16, 2012)

The patient had undergonde closure of colostomy  and coloproctostomy yesterday and had developed chest pain overnight for which a CT scan of the chest was performed wihich showed no evidence of blood clot but did show what appeared to by hemoperitoneum.  As such, repeat CT  of the abd and pelvis confirmed hemoperitoneum along with this JP output. He was taken back to the operating room. placed upon the operating table.

General anesthesia being induced.  Previous staple line staples were removed and in the midline ostomy closure staples were left intact.  A JP drain was prepped in the field from the rt lower quad and then the fascial sutures were cut and opened and the abd was entered.  Hemoperitoneum was identified and evacuated with a pool sucker.  There was a large amt of clot present as well and free blood.  A survey of the abd revealed clotted blood in and about the pelvis, more free blood higher up and this was evacuated with the pool sucker.  The small bowel was run and adhesions were taken down.  An interloop clot was evacuated.

A bookwalter retractor was used.  There  appeared to be no bleeding down from the ostomy closure site of the rectus.  There appeared to be no bleeding down from the JP drain site.  On further inspection of the coloprocotostomy there appeared to be about a 1.5-2.0 cm rent in the rt side of the ostomy with what appeared to be bleeding from the staple line. This also corresponded to the area where a lot of old clot was present. Hemorrhage was controlled with suture and then the coloproctostomy breakdown was closed.

Following this an appendectomy was preformed.  I an not sure why the anastomosis did not bleed out the rectum rather than blow out and bleed into the abd but this is what appeared to have done. Following this and being sure there was no ongoing hemorrage, a loop ileostomy was created in the rt lower quad with an ellipse of skin and subcutaneous tissue Cruciate excision on the rectus and delivery of the loop of terminal ileum about 6" away from the ileocecal valve, came up nicely. It was tacked to the skin with Monocryl.Following this the abd was again irrigated copiously and aspirated dry.  A J-vac drain was placed.  At this point a sigmoidoscopy as performed.  No active bleed into the rectum. 

Sorry it is so lengthy.  Thank you


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## syllingk (Aug 16, 2012)

Okay. I am thinking 44604-78-59, 44310-78, and 44955-79 if the path shows something was wrong with it otherwise it is incidental. 
If you look up hemorrhage abdomen it says 49002 (which says it can be for control of post operative intra abdominal hemorrhage) which is included in both of the two codes above. 

Hope that helps.


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## drhoads (Aug 22, 2012)

Helped a lot.  Thank you


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