# Left inguinal, Expl Lap, Sigmoid Colectomy w/anastomosis



## bill2doc (Apr 10, 2012)

Clueless....I can code each seperate but not sure if there are codes that capture a combo of the services.  Can anyone share what they would code?  Thanks!

1.LEFT INGUINAL HERNIA
2.EXPLORATORY LAP
3.SIGMOID COLECTOMYW/PRIMARY ANASTOMOSIS

Pt had large mass in his left scrotum that was firm and irreducible, anatomic ladmarks of the pubic tubercle and anterior superior iliac spine were indentified. A transverse incision was then made in skin crease and carried down throught the scbcu fat and fascia to revieal the fibers of the external oblique. Oblique then incised and spermatic cord identified. Cord was large and indurated. Significant amount of inflamation. Hernia appeared firm and fixed. Significant effort involved in trying to reduce it from this approach. Given pre-op CT noted colonic involvement, sac was incised and noted bloody fluid returned. Decision made to perform midline laparotomy to safely eval the colon. A lower midline incision made and through subcutaneous tissue to fascia. Fascia incised and abdomen entered. Same bloody fluid noted throughout abdomen. No clots and fluid did not appear to be from new bleeding. Small bowel examined, noted dilated and colon traced to left side where it did not appear obstructed but indurated and herniated through a large defect within the inguinal canal.  Using reduction, external pressure and manipulation of the bowel, colon slowly reduced. Once mass reduced colon examined. Sigmoid colon thinkened cyst-like structure that was adherent to the bowel. The bowel did not appear to be grossly perforated nor did it seem to be the margin of the bloody fluid. There were multiple serosal tears from the reduction process and given the redundancy of entry the bowel decision was made to resect it.  Prior to dissection, attention turned back to hernia where spermatic cord was mobilized. The thickened peritoneal sac dissected from cord and passed off. A large plug placed in defect of canal. An overlying patch was placed and anchored medially to the pubic tubercle, inferiorly to the inguinal ligament and superiorly to the transversalis fascia. Mest inserted and oblique closed.  

Returned back to abdomen, colon noted to be in bad shape and need of resection. The Proximal and distal resection points indentified and linear cutting stapler was then used to transect the colon and mesentery was then divided. The peritoneal sac still attached to both colon and colonic segment was passed off. ends of colon anastomosed using stapler. The colotomy repaired in two layers. Mesenteric defect closed. Retroperitoneal defect closed. Abdomen irrigated and closed

Thanks everyone !!!!


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## jewlz0879 (Apr 11, 2012)

I would think the Exploratory Lap is included; diagnostic is usually included with surgical and since the sigmoid was repaired I don't believe you should bill for the exp lap. 

I'm thinking:
44140
44505 

I'm rather new to General Surgery so if there are more season coders that find I'm wrong, PLEASE correct me. I have no problem with construtive criticism.


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## syllingk (Apr 11, 2012)

Sounds like 44140 and 49507


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## jewlz0879 (Apr 11, 2012)

syllingk said:


> Sounds like 44140 and 49507




Just curious, what in the report made you choose 49507? Was it this: "Pt had large mass in his left scrotum that was firm and irreducible?" Since he mentions the mass was irreducible? I'm trying to understand what I should look for that would indicate 'incarcerated or strangulated.' 

Thanks!


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## bill2doc (Apr 11, 2012)

That was my thinking, the firm and irreducible notes....a BIG thanks to you both!


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## syllingk (Apr 12, 2012)

Yes. If it can't be reduced it is incarcerated.


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