# CPT Code for Laparoscopic Debulking



## sscott@hogonc.com (Apr 21, 2014)

We are new to coding for GYN Oncology.  We have a patient who had a TLH/BSO, pelvic lymph node dissection, complete omentectomy, debulking, and appendectomy.  Can you please help with coding this? We can only find open codes for the debulking.  Below is a copy of the op note.

OP NOTE 

PREOPERATIVE DIAGNOSES:  
1.  Nausea.
2.  Vomiting.
3.  Abdominal pain.
4.  Complex left ovarian mass.

POSTOPERATIVE DIAGNOSES:  Mucinous adenocarcinoma with unknown
primary most consistent with ovarian or appendiceal.

PROCEDURE:  
1.  TLH, BSO.
2.  Pelvic lymph node dissection.
3.  Complete omentectomy.
4.  Debulking of left pelvic sidewall.
5.  Appendectomy.

ESTIMATED BLOOD LOSS:  100.

COMPLICATIONS:  None.

FINDINGS:  The patient has had a bout of nausea and vomiting that is
not subsided.  We proceeded to perform laparoscopic hysterectomy. 
Once we entered, there was a mucinous deposits tumor on the left
pelvic sidewall.  The ovary was attached to it although it was a
little uncertain whether it was originating from.  Once we did the
frozen, it was consistent with a mucinous adenocarcinoma that is
consistent with either ovarian or appendiceal.  Her appendix was
unremarkable, we removed it due to this diagnosis.  She did have
tumor deposits in the omentum measuring approximately 2 cm in
greatest diameter.  Her lymph nodes are not enlarged grossly except
for one on the left pelvic sidewall.  We did debulk the left pelvic
sidewall.  There was no tumor remaining on that greater than 1 cm. 
Her upper abdomen was clean, saved the omentum.  She was tumor free
with the exception of small residual disease along the mesentery of
the sigmoid colon, and I was uncertain whether this was actually
tumor or the debulking the process.  Due to complexity of
laparoscopic debulking, my PA was essential for timely completion of
the case.  She aided in lymph node retrieval, camera manipulation,
uterine manipulation, and port closure.

PROCEDURE:  After informed consent was obtained, the patient taken to
operating room and general endotracheal anesthesia was obtained
without complications.  She was sterilized, prepped, draped in a
sterile fashion.  Foley was inserted.  Time-out was performed, a RUMI
with KOH was then placed.  I then made left upper quadrant incision
so we could ascertain the upper abdomen and then he remaining
structures.  I did see omental disease.  I put in another port so we
could run the colon and small bowel determined if she could actually
be adequately debulked laparoscopically versus open.  I did feel we
could completely remove all visible residual tumor, therefore, we
proceeded with the hysterectomy.  I reflected the colon medially.  I
separated the ureter from the gonadal vessels on the left and
desiccated the gonadal vessels, I desiccated and transected bilateral
round ligaments, made a window posterior leaf of the broad ligament
above the level of ureter on the right and extended and desiccated
the gonadal vessel on the right.  We then created bladder flap,
carried it past KOH applicator, desiccated and transected bilateral
uterines, the leading edge of KOH was used as a guide, created
colpotomy and circumferential dissection for amputation of specimen
which I then delivered through the vagina.  We then placed a balloon
back in the vagina, I then performed a complete omentectomy from the
greater curvature of the stomach.  I delivered it through the vagina.
The open spaces of pelvis removed lymph tissue from middle common
iliac to deep circumflex, medial and lateral border being the _____
superior vesicle.  We performed more debulking in her left pelvic
sidewall.  I then evaluated the bilateral diaphragmatic surfaces,
liver capsule.  The appendix was brought into view.  I desiccated and
transected the mesoappendix and placed a stapler across the appendix
and fired it, placed an EndoCatch bag, brought out through a 10 mm
port, delivered it, places this port.  I then closed the vagina with
a V-Loc suture.  Copious irrigation was performed _____ prior
dissection noted hemostatic.  We then evacuated pneumoperitoneum,
removed the ports, closed skin with 4-0 Monocryl, took her out of
dorsal lithotomy, turned her dorsal supine, extubated, took to
recovery room with stable vital signs.  All counts correct at this
time, there is no intraoperative complications noted.



Thank you for your help!!


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## Anastasia (Apr 24, 2014)

I code gyn oncology and can help you with this but I need more information.
Please send me a private message.


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