BFAITHFUL
Expert
dr. did a diagnostic laparoscopy 49320, and also did an exploration of rectus sheath of left abdominal wall? what would I bill for this if it's not bundled.
DX: Left sided abdominal wall pain rule out spigelian hernia rule out neuroma.
Procedure:
The peritoneum was entered and a 5mm trocar was placed. A 5mm scope to the 30 degree angle was placed. The area of his complaint was marked out with sterile marking pen, this area of the abdominal wall was now examined extensively with the laparoscope and in fact multiple pictures were taken for the record. The area was probed with a finger to make sure that this corresponds to the area of concern.
We now make a transverse incision on the abdominal wall at the area that has been outlined and bring that through the skin and subcutaneous tissue. Self retaining retractor was placed we then opened ups the anterior rectus sheath and extend that incision all the way to the lateral rectus sheath. We examined the area between the rectus and the oblique. We palpate this area and now we placed a finger lateral to the muscle impressed and examined then with the laparoscope and we actually take picture of that finger pressing on the peritoneum posterior rectus sheath itself. Again there is no evidence of any defect and no evidence of any neuroma and no evidence of any kind of nodularity or fowth in this area. Having exhausted all other avenues of exploration. I now inject the area of the abdominal wall with marcaine and closed the fascial layers with interrupted 0 Vicryl 3-0 vicryl subcu for scarpas 3-0 vicryl subcu and then 4-0 monocryl to closed the skin. the fascia of the umbilical wound after releasing the pneumoperitoneum was closed with 0 vicryl on UR needle and then subcuticular monocryl.
DX: Left sided abdominal wall pain rule out spigelian hernia rule out neuroma.
Procedure:
The peritoneum was entered and a 5mm trocar was placed. A 5mm scope to the 30 degree angle was placed. The area of his complaint was marked out with sterile marking pen, this area of the abdominal wall was now examined extensively with the laparoscope and in fact multiple pictures were taken for the record. The area was probed with a finger to make sure that this corresponds to the area of concern.
We now make a transverse incision on the abdominal wall at the area that has been outlined and bring that through the skin and subcutaneous tissue. Self retaining retractor was placed we then opened ups the anterior rectus sheath and extend that incision all the way to the lateral rectus sheath. We examined the area between the rectus and the oblique. We palpate this area and now we placed a finger lateral to the muscle impressed and examined then with the laparoscope and we actually take picture of that finger pressing on the peritoneum posterior rectus sheath itself. Again there is no evidence of any defect and no evidence of any neuroma and no evidence of any kind of nodularity or fowth in this area. Having exhausted all other avenues of exploration. I now inject the area of the abdominal wall with marcaine and closed the fascial layers with interrupted 0 Vicryl 3-0 vicryl subcu for scarpas 3-0 vicryl subcu and then 4-0 monocryl to closed the skin. the fascia of the umbilical wound after releasing the pneumoperitoneum was closed with 0 vicryl on UR needle and then subcuticular monocryl.