# Reduction of hernia and bypass of small-bowel stricture



## asasands (Apr 20, 2011)

If somebody could help with the CPT codes to be used in this situation that would be great.

Procedure:  Reduction of hernia and byass of small-bowel stricture

Op Report:

The lower abd incision made and carried up to the level of the umbilicus through the umbilical hernia.  The subcutaneous tissue was divided with cautery down tot he fascia.  Fascia was opened, some subcutaneous tissue was divided with cautery down to the fascia.  Fascia was opened, some ecchymosis was noted at the peritoneum and the peritoneum was opened.  Incision was extended inferiorly and superiorly with cautery being careful the bowel underneath.  The bowel was erythematous and injtected but appeared quite viable.  Dissection carried out proximally from the ileocecal vlave to collapse bowel to the anterior adhesions.  The omentum was noted attached to the small bowel where some gallstones were present.  Adhesions were lysed freeing up the small bowel, releasing an internal hernia.  The bowel was inspected, though was quite dilated approximately, collapse distally and in between was a stricture which did not dilate given fair amount of time.

Since this is not dilated, ti was elceted to bypass the segment, bowel was brought together and held with sil suture.  Enterotomy was made on each side of the stricture.  Side-toside anastomosis was then created.  The small bowel returned to its normal position and the omentum was pulled down over the bowel.

The peritoneum and fascia were then closed with running looped PDS suture including the repair of the umbilical hernia.  Subcutaneous tissue was irrigated and skin was closed with staples.

Any help would be appreciated,

Thanks

Stacey, CPC


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## newmanla (Apr 20, 2011)

Stacy look at 44130 for the small bowel resection. 49585 for the hernia.


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