cubbiecatz
Networker
I know for the vaginal cuff dehiscence it would be an unlisted code, but he did more than just repair the cuff and I'm not sure if there is a better code or what code should I compare it to for reimbursement?
Per discussion with the provider, it resulted from the patient having intercourse too soon after the hysterectomy.
ROBOTIC LAPAROSCOPY:
Pre-operative Diagnosis:
7 weeks S/P RAVH with BS
Pneumoperitoneum
Post-operative Diagnosis:
7 weeks S/P RAVH with BS
Pneumoperitoneum
Vaginal cuff dehiscence after intercourse
Operation: 1) Exam under anesthesia 2) robotic assisted laparoscopy with peeling of the sigmoid colon epiploica from the vaginal cuff and then cuff closure
Surgeon: M.D.
Assistant: None. Intraoperative consult with Dr. A with general surgery.
Anesthesia: General endotrachial
Complications: None
Specimens: None
Estimated Blood Loss: Less than 5 mL
Disposition: PACU - hemodynamically stable.
Condition: stable
Procedure Details:
The patient was seen in the Holding Room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient concurred with the proposed plan, giving informed consent. The patient was taken to Operating Room, identified and the procedure verified as robotic assisted laparoscopy with peeling of the sigmoid colon epiploica from the vaginal cuff and then cuff closure. A Time Out was held and the above information confirmed.
After induction of anesthesia, the patient was carefully positioned and padded, placed in Pal stirrups, prepped, and draped in the usual sterile manner. Foley catheter was placed.
A weighted speculum was placed in the vagina. Upon visualizing the vaginal cuff, it was noted to be completely open and there was a mass protruding through it. It was phlegmon appearing. It was decided to perform the robotic laparoscopy. Gloves were changed. A supraumbilical incision was made and a 5 mm blameless trocar was inserted into the peritoneal cavity under direct visualization. The abdomen was insufflated with carbon dioxide gas. Under direct vision, two eight millimeter robotic ports were placed. 8 mm camera port was then placed in the 5 mm port site. The robot was then docked.
A fenestrated bipolar was placed in the left robotic port and guided into the pelvis. A needle driver was placed in the right robotic port and guided into the pelvis. Control was then turned over to the physician console.
On examination of the pelvis, the colon was noted to be stuck to the vaginal cuff.
The colon was adhered to the vaginal cuff and it was peeled off of the vaginal cuff without any issue. Dr. A was brought in as an intraoperative consult to visualize the colon. We both felt that the area involved was the epiploica of the sigmoid colon and did not involve the actual mucosa of the colon itself. There is no evidence of necrosis or devascularization. The vaginal cuff was then closed with a V-Loc suture beginning at the right apex and going to the left apex and then oversewing this on the left-hand side with a locking suture. The cuff appeared intact at this point and hemostatic. There was noted to be some small oozing, so Arista was placed on the vaginal cuff. This completed the procedure.
The instruments were removed and the robot was undocked. Gas was allowed to escape from the sleeves and the sleeves were removed. The skin was closed with skin clips and band-aids applied.
Sponge, needle, and instrument count was correct. The patient was wakened and taken to the recovery room in good condition.
Thank you, Cathy, CPC, COBGC
Per discussion with the provider, it resulted from the patient having intercourse too soon after the hysterectomy.
ROBOTIC LAPAROSCOPY:
Pre-operative Diagnosis:
7 weeks S/P RAVH with BS
Pneumoperitoneum
Post-operative Diagnosis:
7 weeks S/P RAVH with BS
Pneumoperitoneum
Vaginal cuff dehiscence after intercourse
Operation: 1) Exam under anesthesia 2) robotic assisted laparoscopy with peeling of the sigmoid colon epiploica from the vaginal cuff and then cuff closure
Surgeon: M.D.
Assistant: None. Intraoperative consult with Dr. A with general surgery.
Anesthesia: General endotrachial
Complications: None
Specimens: None
Estimated Blood Loss: Less than 5 mL
Disposition: PACU - hemodynamically stable.
Condition: stable
Procedure Details:
The patient was seen in the Holding Room. The risks, benefits, complications, treatment options, and expected outcomes were discussed with the patient. The patient concurred with the proposed plan, giving informed consent. The patient was taken to Operating Room, identified and the procedure verified as robotic assisted laparoscopy with peeling of the sigmoid colon epiploica from the vaginal cuff and then cuff closure. A Time Out was held and the above information confirmed.
After induction of anesthesia, the patient was carefully positioned and padded, placed in Pal stirrups, prepped, and draped in the usual sterile manner. Foley catheter was placed.
A weighted speculum was placed in the vagina. Upon visualizing the vaginal cuff, it was noted to be completely open and there was a mass protruding through it. It was phlegmon appearing. It was decided to perform the robotic laparoscopy. Gloves were changed. A supraumbilical incision was made and a 5 mm blameless trocar was inserted into the peritoneal cavity under direct visualization. The abdomen was insufflated with carbon dioxide gas. Under direct vision, two eight millimeter robotic ports were placed. 8 mm camera port was then placed in the 5 mm port site. The robot was then docked.
A fenestrated bipolar was placed in the left robotic port and guided into the pelvis. A needle driver was placed in the right robotic port and guided into the pelvis. Control was then turned over to the physician console.
On examination of the pelvis, the colon was noted to be stuck to the vaginal cuff.
The colon was adhered to the vaginal cuff and it was peeled off of the vaginal cuff without any issue. Dr. A was brought in as an intraoperative consult to visualize the colon. We both felt that the area involved was the epiploica of the sigmoid colon and did not involve the actual mucosa of the colon itself. There is no evidence of necrosis or devascularization. The vaginal cuff was then closed with a V-Loc suture beginning at the right apex and going to the left apex and then oversewing this on the left-hand side with a locking suture. The cuff appeared intact at this point and hemostatic. There was noted to be some small oozing, so Arista was placed on the vaginal cuff. This completed the procedure.
The instruments were removed and the robot was undocked. Gas was allowed to escape from the sleeves and the sleeves were removed. The skin was closed with skin clips and band-aids applied.
Sponge, needle, and instrument count was correct. The patient was wakened and taken to the recovery room in good condition.
Thank you, Cathy, CPC, COBGC
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