knperry
Guru
I need some help with this surgery. I coded the exploratory laparotomy with 49000 but I can't find a code for the abdominal washout. Is this included w/the primary code? Surgery note reads as follows:
OPERATION IN DETAIL: Ms. Holloway was brought back to the operating room on 7/13/2012 and placed in the supine position on the operating room table and SCD was already in place on her right lower extremity and was hooked up to the machine. General anesthesia was then induced without incident. Her abdomen was then prepped and draped in sterile fashion. Timeout was performed. A midline incision was made and electrocautery was used to dissect down to the anterior abdominal wall. The fascia was scored and a hemostat was used topuncture through the anterior fascia. We were then able to open up the anterior abdominal wall fascia with electrocautery. The peritoneum was then grasped between 2 hemostats and cut using the electrocautery to enter the intraabdominal space. Large amount of old blood within it immediately evacuated from her intraabdominal space. Once this had been adequately suctioned to allow visualization, completely opened the peritoneum and began to suction out any remaining old blood that we were able to visualize. There was no active blood present in the abdomen. We then turned our attention to her pelvis and suctioned out old blood that was present there and extended our incisions proximally and distally to allow us better visualization. The falciform ligament was then divided between 2 Kelly clamps using 0 Vicryl ties. The abdomen was then copiously irrigated with warm irrigation until it returned clear. Next, we looked at her right liver, which was completely intact and smooth along the dome of the liver. Next, we looked at the left lobe of her liver. There was some omentum that was helping to provide hemostasis along the liver fracture. There was no active bleeding coming from the liver fracture. The spleen was examined manually and intact. Next, we examined her right transverse and left colon and sigmoid colon, all were uninjured. There was no retroperitoneal blood. We then looked down in her pelvis. Her uterus was placed and she has some bulky stool in the rectum. There was no injury noted in her pelvis. We then ran her small bowel from the ligament of Treitz to the terminal ileum. Her mesentery and small bowel were completely intact. We irrigated further with warm irrigation. We packed her liver laceration with Gelfoam and placed the omentum behind the Gelfoam to create a tamponade effect along the liver laceration. At this, we felt like we had adequately investigated her abdomen and found no other injuries and decision was made to close. Her abdominal wall fascia was closed using two #1looped PDSs in running fashion. One piece of Seprafilm was placed into the intraabdominal cavity before completing our fascial closure to prevent adhesive disease if further exploration was needed. Once the fascia was closed, the wound was irrigated again with some warm saline and then the skin was closed using a skin stapler. Sterile dressing of fluffs and Primapore was placed. At this time, the procedure was concluded. Ms. Holloway was left intubated and transferred back to her ICU bed and transported to the ICU where she will continue to receive resuscitation with cryoprecipitate, platelets and FFP.
Thanks!
OPERATION IN DETAIL: Ms. Holloway was brought back to the operating room on 7/13/2012 and placed in the supine position on the operating room table and SCD was already in place on her right lower extremity and was hooked up to the machine. General anesthesia was then induced without incident. Her abdomen was then prepped and draped in sterile fashion. Timeout was performed. A midline incision was made and electrocautery was used to dissect down to the anterior abdominal wall. The fascia was scored and a hemostat was used topuncture through the anterior fascia. We were then able to open up the anterior abdominal wall fascia with electrocautery. The peritoneum was then grasped between 2 hemostats and cut using the electrocautery to enter the intraabdominal space. Large amount of old blood within it immediately evacuated from her intraabdominal space. Once this had been adequately suctioned to allow visualization, completely opened the peritoneum and began to suction out any remaining old blood that we were able to visualize. There was no active blood present in the abdomen. We then turned our attention to her pelvis and suctioned out old blood that was present there and extended our incisions proximally and distally to allow us better visualization. The falciform ligament was then divided between 2 Kelly clamps using 0 Vicryl ties. The abdomen was then copiously irrigated with warm irrigation until it returned clear. Next, we looked at her right liver, which was completely intact and smooth along the dome of the liver. Next, we looked at the left lobe of her liver. There was some omentum that was helping to provide hemostasis along the liver fracture. There was no active bleeding coming from the liver fracture. The spleen was examined manually and intact. Next, we examined her right transverse and left colon and sigmoid colon, all were uninjured. There was no retroperitoneal blood. We then looked down in her pelvis. Her uterus was placed and she has some bulky stool in the rectum. There was no injury noted in her pelvis. We then ran her small bowel from the ligament of Treitz to the terminal ileum. Her mesentery and small bowel were completely intact. We irrigated further with warm irrigation. We packed her liver laceration with Gelfoam and placed the omentum behind the Gelfoam to create a tamponade effect along the liver laceration. At this, we felt like we had adequately investigated her abdomen and found no other injuries and decision was made to close. Her abdominal wall fascia was closed using two #1looped PDSs in running fashion. One piece of Seprafilm was placed into the intraabdominal cavity before completing our fascial closure to prevent adhesive disease if further exploration was needed. Once the fascia was closed, the wound was irrigated again with some warm saline and then the skin was closed using a skin stapler. Sterile dressing of fluffs and Primapore was placed. At this time, the procedure was concluded. Ms. Holloway was left intubated and transferred back to her ICU bed and transported to the ICU where she will continue to receive resuscitation with cryoprecipitate, platelets and FFP.
Thanks!