KBean2018
Guru
Hello, would the below procedure qualify for modifier 59? 49561-59, 47563-51?
A 2 inch transverse incision was made overlying the incarcerated ventral hernia was located at the supraumbilical position. There was a golf ball sized hernia sac containing preperitoneal fat and omentum. The sac was excised and the incarcerated omentum was suture ligated with 0 silk suture and the excess excised. This left a 2 cm fascial defect. This allowed for placement of a 12 mm Hassan trocar. The abdomen was then insufflated to 15 mmHg pressure and carbon dioxide the 0°, 10 mm camera was then inserted and the abdomen was inspected (see findings). Under direct vision a 5 mm bladed trocar was placed in the subxiphoid position and 2, 5 mm ports were placed in the right upper quadrant. The patient was then positioned reverse Trendelenburg, left lateral tilt.
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The gallbladder was then retracted in a cephalad manner using 2, 5 mm graspers. Due to the acute edema within the gallbladder, a cholecystostomy was created with a grasping forceps and the gallbladder decompressed of dark green bile. The Maryland dissector was used to create a posterior window behind the cystic duct. The cystic duct junction with the gallbladder was clearly identified. The duct was milked towards the gallbladder junction. The cystic duct was singly clipped distally and plans were made for intraoperative cholangiogram.
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A stab incision was performed in the right upper quadrant and the taut catheter introducer placed. The 4.5 French taut catheter was primed with full-strength contrast and saline. The cystic duct was partially divided allowing for placement of the taut catheter that was clipped in place. Intraoperative cholangiogram was then performed. There is no biliary ductal dilation. There is no evidence of choledocholithiasis. The contrast emptied quickly into the duodenum. The distal pancreatic duct also visualized consistent with a common ampulla. Following completion of the intraoperative cholangiogram, the taut catheter was removed from the cystic duct that was then doubly clipped proximally and completely divided. The cystic artery was also identified going to the gallbladder. This structure was also clipped proximally and distally and then divided. The gallbladder was then peeled away from the liver bed using electrocautery. Once detached from the liver bed it was withdrawn from the periumbilical port site in a routine manner. The gallbladder was sent to pathology
A 2 inch transverse incision was made overlying the incarcerated ventral hernia was located at the supraumbilical position. There was a golf ball sized hernia sac containing preperitoneal fat and omentum. The sac was excised and the incarcerated omentum was suture ligated with 0 silk suture and the excess excised. This left a 2 cm fascial defect. This allowed for placement of a 12 mm Hassan trocar. The abdomen was then insufflated to 15 mmHg pressure and carbon dioxide the 0°, 10 mm camera was then inserted and the abdomen was inspected (see findings). Under direct vision a 5 mm bladed trocar was placed in the subxiphoid position and 2, 5 mm ports were placed in the right upper quadrant. The patient was then positioned reverse Trendelenburg, left lateral tilt.
*
The gallbladder was then retracted in a cephalad manner using 2, 5 mm graspers. Due to the acute edema within the gallbladder, a cholecystostomy was created with a grasping forceps and the gallbladder decompressed of dark green bile. The Maryland dissector was used to create a posterior window behind the cystic duct. The cystic duct junction with the gallbladder was clearly identified. The duct was milked towards the gallbladder junction. The cystic duct was singly clipped distally and plans were made for intraoperative cholangiogram.
*
A stab incision was performed in the right upper quadrant and the taut catheter introducer placed. The 4.5 French taut catheter was primed with full-strength contrast and saline. The cystic duct was partially divided allowing for placement of the taut catheter that was clipped in place. Intraoperative cholangiogram was then performed. There is no biliary ductal dilation. There is no evidence of choledocholithiasis. The contrast emptied quickly into the duodenum. The distal pancreatic duct also visualized consistent with a common ampulla. Following completion of the intraoperative cholangiogram, the taut catheter was removed from the cystic duct that was then doubly clipped proximally and completely divided. The cystic artery was also identified going to the gallbladder. This structure was also clipped proximally and distally and then divided. The gallbladder was then peeled away from the liver bed using electrocautery. Once detached from the liver bed it was withdrawn from the periumbilical port site in a routine manner. The gallbladder was sent to pathology