Codehound1
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How would this be coded? Thanks!
PREOP and POSTOPERATIVE DIAGNOSIS: Colostomy status.
PROCEDURES PERFORMED:
Colostomy take down.
Low anterior resection.
SURGEON: XXXXX
SPECIMENS:
Colostomy.
Rectosigmoid.
OPERATIVE FINDINGS: End-colostomy and rectal stump consistent with prior sigmoid resection for diverticulitis.
DESCRIPTION OF PROCEDURE: After obtaining informed consent, the patient was taken to the operating room and underwent induction of general anesthesia. He was placed in a low-modified lithotomy position with all pressure points well padded. His abdomen was prepped and draped in standard sterile surgical fashion. The abdomen was entered through about 5-inch incision about the lower midline, excising the previous scar and dissected down to the fascia, which was then opened and the abdomen was entered. Minimal adhesions were taken down easily with electrocautery and scissors. The colostomy was then mobilized by creating an incision about the mucocutaneous junction and dissected through the subcutaneous tissues until the colostomy was able to be pulled into the abdomen. Again, a few additional adhesions were removed from the abdominal sidewall attached to the ostomy, which gave us excellent length to reach down into the low pelvis. (The patient's splenic flexure have been mobilized during previous surgery). I packed the small bowel away and we mobilized the upper rectum, I opening the presacral space and dissecting down to the level of the mid rectum and then performed a corresponding lateral dissections on either side. The rectosigmoid junction was then identified at the termination of the tinea and the mesorectum/mesocolon was divided at this level using the LigaSure. The rectum was then divided at this level using a contour stapler. The anvil of the 31-mm EEA stapler was then fixed into the distal colon and the very end of the colostomy was removed and sent as a specimen. The rectum was dilated sequentially and then the stapler passed up to the rectal apex and the spike was advanced and coupled with the anvil and then after ensuring no twisting or incorporation of extraneous tissue. The staple was closed and fired with resulting in 2 complete rings. The transverse staple line was oversewn with 3-0 Vicryl Lembert sutures and anchoring stitches were placed in either side and one anteriorly as well in the anterior midline. An underwater leak test was then performed with rigid proctoscope revealing no leak. Hemostasis was observed. The viscera returned to their anatomic positions. The fascia of the ostomy site was closed in 2 layers using #1 PDS. The fascia of the lower midline was closed with a running #1 looped PDS suture.
The patient tolerated the procedure well and all sponge and instrument counts were performed x2 and reported to me as correct at the conclusion of the procedure. The skin was closed with a running 4-0 Vicryl subcuticular suture in the lower midline and a 2-0 Biosyn pursestring suture was used for the ostomy site, which was also packed.
PREOP and POSTOPERATIVE DIAGNOSIS: Colostomy status.
PROCEDURES PERFORMED:
Colostomy take down.
Low anterior resection.
SURGEON: XXXXX
SPECIMENS:
Colostomy.
Rectosigmoid.
OPERATIVE FINDINGS: End-colostomy and rectal stump consistent with prior sigmoid resection for diverticulitis.
DESCRIPTION OF PROCEDURE: After obtaining informed consent, the patient was taken to the operating room and underwent induction of general anesthesia. He was placed in a low-modified lithotomy position with all pressure points well padded. His abdomen was prepped and draped in standard sterile surgical fashion. The abdomen was entered through about 5-inch incision about the lower midline, excising the previous scar and dissected down to the fascia, which was then opened and the abdomen was entered. Minimal adhesions were taken down easily with electrocautery and scissors. The colostomy was then mobilized by creating an incision about the mucocutaneous junction and dissected through the subcutaneous tissues until the colostomy was able to be pulled into the abdomen. Again, a few additional adhesions were removed from the abdominal sidewall attached to the ostomy, which gave us excellent length to reach down into the low pelvis. (The patient's splenic flexure have been mobilized during previous surgery). I packed the small bowel away and we mobilized the upper rectum, I opening the presacral space and dissecting down to the level of the mid rectum and then performed a corresponding lateral dissections on either side. The rectosigmoid junction was then identified at the termination of the tinea and the mesorectum/mesocolon was divided at this level using the LigaSure. The rectum was then divided at this level using a contour stapler. The anvil of the 31-mm EEA stapler was then fixed into the distal colon and the very end of the colostomy was removed and sent as a specimen. The rectum was dilated sequentially and then the stapler passed up to the rectal apex and the spike was advanced and coupled with the anvil and then after ensuring no twisting or incorporation of extraneous tissue. The staple was closed and fired with resulting in 2 complete rings. The transverse staple line was oversewn with 3-0 Vicryl Lembert sutures and anchoring stitches were placed in either side and one anteriorly as well in the anterior midline. An underwater leak test was then performed with rigid proctoscope revealing no leak. Hemostasis was observed. The viscera returned to their anatomic positions. The fascia of the ostomy site was closed in 2 layers using #1 PDS. The fascia of the lower midline was closed with a running #1 looped PDS suture.
The patient tolerated the procedure well and all sponge and instrument counts were performed x2 and reported to me as correct at the conclusion of the procedure. The skin was closed with a running 4-0 Vicryl subcuticular suture in the lower midline and a 2-0 Biosyn pursestring suture was used for the ostomy site, which was also packed.