# Exp laparoscopy w/lavage and placement of drains



## meo59101 (Apr 6, 2016)

Hi everyone
Wondering if someone (anyone?!) could suggest a CPT code for this procedure.  The closest one I can come up with is 49082, but that doesn't include placement of the drains, which (as far as I can tell) would leave me with an unlisted code, 49329.  Thanks very much for taking a look.
Molly

Preoperative Diagnosis:  Bile peritonitis.
Postoperative Diagnosis:  Bile peritonitis.

Procedure:  Exploratory laparoscopy with peritoneal lavage and placement of
3 Blake drains for control of hepatic laceration and bile leakage.

Anesthesia:  General.

Estimated Blood Loss:  Minimal.

Implants:  Blake drains, 19 French x3, right drain over the right lobe of
the liver, mid drain beneath the liver and tracking up under the
gastrohepatic ligament, left lobe space, and the left drain extending over
the spleen beneath the diaphragm.

Wound classification:  1.

Description:  The patient was taken to the operating room and after
induction of general anesthesia, was prepped and draped in normal sterile
fashion. A Veress needle puncture was made in the left upper quadrant.
Pneumoperitoneum achieved.  A 5 mm trocar was placed in the midline.  Under
direct visualization, two 5 mm ports were placed in the right abdomen and
another 5 mm port was placed in the midclavicular line on the left. The
patient had some dark fluid in the pericolic gutters bilaterally and over
the spleen and liver. I suctioned out about 800 mL of fluid, and there was
an obvious crack in the liver onto the right and to the left of the
falciform ligament. It appeared to go through most of the body of the
liver. The liver on both sides appeared to be well perfused. There was no
sign of any ischemia. There was no sign of any active bleeding. The abdomen
was then lavaged with several liters of saline which was then suctioned
out. There was some obvious staining of the peritoneum with bile but once
all the bile and fluid was suctioned out as best as possible, three 19
French Blake drains were open. One was placed over the dome of the liver
along the right pericolic gutter. The middle drain was then placed between
the hepatic flexure and liver extending up between the stomach and the left
lobe of the liver. The left-sided drain was placed over the spleen between
that and the spleen and the hemidiaphragm. The ends of these drains were
brought out with the corresponding 5 mm port sites. The final port site was
closed with a 4-0 Monocryl and Dermabond glue. Drains were sutured in
place. The patient tolerated the procedure well.


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