# Laparascopic cecectomy



## nlbarnes (Mar 27, 2017)

44970 or 44160-52, 44204-52, or 49329?

The surgeon informed me that "44970 - This code is the closest to what I did.  The appendix was already out.  There was a possible mucocele at the appendix stump so I laparoscopically took off the base of the cecum to include the appendiceal stump. There is no code for this that I am aware of".

PROCEDURE PERFORMED:  LAPAROSCOPIC CECECTOMY

A #5 trocar was placed in the 
left upper quadrant.  #5, 30-degree laparoscope was placed in the 
abdomen.  There was no evidence of bowel or blood vessel injury. 
Under direct vision, #12 trocar was placed in the left mid quadrant, 
#5 trocar in the lower midline, and #5 trocar in the right upper 
quadrant.  The ink placed by the gastroenterologist was immediately 
seen in the cecum at a location consistent with the appendiceal stump.  The  
white line of Toldt on the patient's right side opposite the cecum was taken  
down with the #5 EnSeal.  Some adhesions of the terminal ileal mesentery to  
the sidewall were taken down with a #5 EnSeal.  We then grasped the fat pad on  
the terminal ileum and held that superiorly so we could see where the terminal  
ileum was entering the cecum at the ileocecal valve.  We then dissected the  
fat off the cecum that was distal and inferior to the ileocecal valve using  
the #5 EnSeal to carefully dissect off all this fat taking care to avoid 
injury to the bowel itself.  Once we had completely cleaned off the 
inferior bulb of the cecum at the point we had chosen for division, we then  
passed an Endo- GIA 60 blue reticulating stapler and positioned it so that it  
was just inferior to the ileocecal valve, so that it should not impinge on the  
ileocecal valve, and this definitely also would give us a specimen that would 
include all the ink in the specimen, we fired the stapler once and 
then we had to fire a second time to come all the way across the cecum 
on the lateral side.  We then placed the portion of cecum in a plastic bag and 
removed it via the left mid quadrant port site.  I peeled off the 
staple line with the scissor on the back table and everted the 
specimen and I was frankly not sure that I could see any actual mass 
at the appendiceal stump, but in any case, we have now removed the 
area that the gastroenterologist questioned a mass and pathology will 
be able to examine it to see if there is indeed any lesion there. 
Certainly, there was no obvious cancer and since we felt we had 
removed the appendiceal stump with the ink without impinging on the 
ileocecal valve, there was no indication at this time for right colectomy.   
Hemostasis was achieved with a #5 EnSeal.  The right lower quadrant was  
irrigated with normal saline.  All was dry at closure. The liver appeared  
grossly normal in the portions we could see and the gallbladder appeared  
normal. The bowel superficially appeared normal. The left mid quadrant 12 port  
site was closed with a 0 Vicryl Endo Close.  All ports were removed under  

613108451 032417


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## CELADYBUG13 (Mar 28, 2017)

This is a case I would definitely wait for the path - that will tell you exactly what was or was not removed and clarify your CPT.


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## nlbarnes (Mar 28, 2017)

*Cecectomy*



CELADYBUG13 said:


> This is a case I would definitely wait for the path - that will tell you exactly what was or was not removed and clarify your CPT.



Thanks for the reminder Celadybug.


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## syllingk (Apr 4, 2017)

take a look at 44202


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## syllingk (Apr 4, 2017)

Sorry, didn't mean to put a small intestine code on there. sounds like a partial colectomy but I can't tell from the note if there was an anastomosis or not.


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## FTessaBartels (May 2, 2017)

*Unlisted - 44238*

I would use 
CPT 44238 Unlisted laparoscopy procedure, intestine

I would base my fee on 44970, laparoscopy surgical, appendectomy

I think the surgeon's note to you is really instructive ... the surgeon feels lap appendectomy is the closest to what was performed. However since the appendix was already removed, you really can't use that code.


Interesting case!

Hope that helps,

F Tessa Bartels, CPC, CEMC


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