# liver biopsy with lap chole



## lindacoder (Apr 29, 2015)

I think this has been discussed before but would still like some imput:

PREOPERATIVE DIAGNOSIS:  Biliary colic.



POSTOPERATIVE DIAGNOSIS:  Biliary colic, plus liver metastases, unknown  primary.



OPERATION PERFORMED:  Diagnostic laparoscopy with cholecystectomy and left  lobe liver mass excision.



INDICATIONS FOR PROCEDURE:  A 61-year-old female who has been having  epigastric right upper quadrant pain.  She had an ultrasound that shows  biliary sludge.  She now is to undergo laparoscopic cholecystectomy.



DESCRIPTION OF PROCEDURE:  In the supine position, the abdomen was prepped and  draped in the usual fashion.  After anesthetizing with 0.25% Marcaine,  supraumbilical transverse incision was made.  Under direct visualization, a 5  mm Optiview port was placed.  The abdomen was insufflated with 15 cm pressure.  Incision was made epigastric and a 10 mm port was placed under direct  visualization and two 5 mm ports in the right subcostal margin.  Upon looking  around, she was found to have diffuse liver mets, probably anywhere from 5 mm  to 1 cm in size, scattered throughout both lobes, I did an excisional biopsy  of one on the left lobe.  Hemostasis obtained with electrocautery.  The  pathologist looked at it and it is consistent with adenocarcinoma duct in  origin.   



After ensuring that that site was dry, I grasped the liver and retracted  cephalad.  The cystic duct was dissected free.  It was small in size and  junction visualized, therefore, cholangiogram was not performed.  Cystic duct  was clipped proximally twice, distally once and divided.  The cystic artery  was dissected free, it was clipped proximally twice, distally once and  divided.  Gallbladder was taken off the liver bed with electrocautery.  After  freeing it completely, it was placed in a specimen bag and brought out through  the epigastric port.  The port was placed.  After ensuring hemostasis at that  site, I looked at her small bowel and looked normal.  I looked at her colon;  what I could see externally I did not see signs of any lesions.  I could not  see any definite etiology for this liver primary, but it was somewhat  difficult to visualize due to her size.  After ensuring that there was  hemostasis, the instruments and ports were removed.  The epigastric fascia was  approximated with interrupted 2-0 Vicryl, skin edges closed with interrupted  4-0 Monocryl subcuticular stitch.  Steri-Strips and a sterile dressing was  applied.  Estimated blood loss:  Minimal.  Sponge and needle counts were  correct.  She tolerated the procedure and was taken to the recovery room in  satisfactory condition.

By pathology biopsy was 1.8 x 1.0 x 0.6 cm consistent with adenocarcinoma. 

Not sure if I can use 47379 with comparison to open code 47001 since it is an add-on code.

Any help is appreciated.


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## tcooper@tupelosurgery.com (Apr 30, 2015)

Good Morning..I code for General Surgery and I use the 47379 and compare it to code 47100. Looking at your posted operative note that is what I would use.
Hope this helps.
Teresa


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## MEZIESKY (Apr 30, 2015)

I also coded for general surgery and I agree. That's what we also use.
47379 with "like" code 47100

mg


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