# Release of internal hernia & SB Resection



## LaceyCanon (Apr 21, 2015)

Can someone please help? I was thinking only the 44120 for the SB resection could be charged, but then maybe 44050 or 44055.

The patient taken to the operating room and administered general endotracheal anesthesia.  The right IJ area was prepped and draped in a sterile fashion and using the ultrasound and fluoroscopic guidance to prevent any manipulation of the pacemaker wires.  The IJ was entered, a wire placed, tract dilated and a triple-lumen catheter was threaded over the wire and into the vein.  All 3 ports were noted to flush and aspirate without difficulty.  The line was sutured in place.  The abdomen was prepped and draped and then entered through a midline incision.  The abdomen was explored.  The transverse colon was elevated.  The NG tube was noted to be in good position and the small bowel was noted to be infarcted and completely black to an internal hernia by 5-6 mm wide adhesion in the right lower quadrant.  This adhesion was divided with the Bovie electrocautery.  The bowel was then untwisted and brought out, and its mesentery laid out.  The bowel was then divided at the sites of the clear demarcation of ischemia.  The mesentery was divided with clamps and ties and the specimen was removed from the field, measured, noted to be about at 85 cm in length or so.  The bowel were remaining was then thoroughly evaluated and felt to be a little discolored although there was peristalsis it was elected to take a few more centimeters on either side to assure adequate profusion of the segments to be used for re-establishing GI continuity, an extra 10 cm were taken.  Approximately 100 cm ischemic intestine were taken; however, obviously this intestine was swollen and markedly edematous and therefore the exact length of this piece if it were normal intestine  was difficult to ascertain.  There was plenty of small bowel left it distally and proximally, as this was mid to distal jejunum or proximal ileum that was removed.  The GIA was used to divide the intestine and the mesentery was all divided between clamps and ties.  Doppler signals were noted to be throughout the mesentery and the cut end of the bowels had an excellent blood supply.  The bowel was then placed side-to-side.  An anastomosis was constructed with a single firing of the 60 mm purple load Endo-GIA.  The resultant enterotomy was closed with a running 3-0 Maxon stitch and oversewn with interrupted 3-0 silk Lembert.  The defect in the mesentery was oversewn with an interrupted 3-0 silk Lembert.  The abdomen was thoroughly and copiously irrigated and after an accurate sponge count, the abdomen was closed with interrupted Dexon from each end meeting and tying in the middle.  Subcutaneous tissue was thoroughly irrigated and stapled.  The patient was then awakened, extubated, and returned to the recovery room after having tolerated the procedure well.  Estimated blood loss minimal.  The sponge and instruments were accounted for.


Any help is appreciated.


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

Good Morning....I think you should be able to use the 44120 and the 44050 for the reduction of internal hernia. I looked at the CCI Edits and it does not show these codes as bundled. I would give it a try. Hope this helps...
Teresa


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