# Need help with Wedge resection of sigmoid colon



## mstafford (Dec 8, 2016)

Im still fairly new to coding General surgery and this one has me stumped.

The surgeon performed a Wedge Resection of sigmoid colon mass with primary closure

Here's the operative report, any help would be greatly appreciated:

DESCRIPTION OF PROCEDURE: The is a surgical operation, which is an emergency consult in the operating room, operating room, Dr. H, consulted me for evaluation and management of a palpable mass in the distal sigmoid close to the rectosigmoid in location on the antimesenteric surface. It was a 1 to 2 cm palpable nodule involving the serosa and wall of the colon on the antimesenteric
surface. This patient had a preoperative mechanical bowel prep. My recommendation was for wedge resection of this particular lesion. This patient had also had a preoperative colonoscopy that showed no evidence of endometriosis evident on the mucosal side of the colon with a total colonoscopy being performed a couple of weeks prior operation by another physician. I had seen
this patient Monday in the office in preparation for the surgery today and I recommended a 2-day bowel prep in case there was need for management of the colon. Dr. H was concerned that this lesion may be endometriosis and I agreed that excision by wedge resection would be appropriate. Soft bowel clamps were used to exclude this segment of the bowel. Metzenbaum scissors were used to excise this transmural nodule which was sent for frozen section and confirmed to be endometriosis by the pathologist. I elected to close the colotomy wedge resection margins with 2 strands of running 2-0 Vicryl, Connell-type stitches, maintaining an excellent lumen. Hemostasis was excellent. Bowel wall viability was excellent. There was no spillage of consequence from the colon. The area was irrigated copiously with normal saline and aspirated and blotted dry. Hemostasis was excellent. A second row of 3-0 silk seromuscular Lemberts were used to close additional layer on top of the Vicryl closure and the lumen was again palpated by all surgical participants to confirm adequate patency of a distal colon wedge resection anastomotic closure.
The patient tolerated the procedure well without complication. As mentioned, frozen section confirmed the pathology as endometriosis. Dr. H also requested an appendectomy because of the presence of endometriosis in the appendix and the retrocecal nature of the appendix. Therefore, an appendectomy was equally performed with traditional technique, mobilizing the appendix from the cecum and its retrocecal position with the Metzenbaum scissors. Hemostasis were necessary with the electrocautery, take down of the mesentery, the appendix
with hemostats and 0 silk ties, 2-0 silk seromuscular pursestring around the base of the appendix and the cecum. Transection after crushing the appendix with a straight hemostat was obtained with ligation of 0 chromic around the appendix. Transection distal to this, inversion of the stump of the appendix, tied down of the purse string suture and then an additional second 2-0 silk Z stitch which further inverted the stump of the appendix and closed the serosa. Hemostasis was excellent. Again, I am requesting that in the preoperative diagnoses: For my operative dictation, it is limited to the surgery performed on the sigmoid colon as well as secondly an pen appendectomy, both done through a preexisting midline laparotomy incision.


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## cpc2007 (Dec 8, 2016)

For the wedge resection of the mass of the colon, I would code 44110 (this code includes a single colotomy into the colon with a localized removal of only a lesion/mass without removing a large area of the bowel and having to perform an anastomosis to reconnect the remaining ends of the bowel).  You can also code add on code 44955 for the appendectomy since the appendix is diseased (he says that there are endometria in the appendix).  

I hope that helps!


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## mstafford (Dec 15, 2016)

cpc2007 said:


> For the wedge resection of the mass of the colon, I would code 44110 (this code includes a single colotomy into the colon with a localized removal of only a lesion/mass without removing a large area of the bowel and having to perform an anastomosis to reconnect the remaining ends of the bowel).  You can also code add on code 44955 for the appendectomy since the appendix is diseased (he says that there are endometria in the appendix).
> 
> I hope that helps!



Thank you so much!!!


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