CCANTER
Networker
i was thinking possibly CPT code 47490. My surgeon does not agree. So then my only other idea was CPT code 49320 with mod 22?
Operation: Exploratory laparoscopy with extensive lysis of adhesions totaling 1 hour and insertion of cholecystostomy tube under laparoscopic guidance
A 5 mm trocar was attempted to be placed in the upper midline which was ultimately unsuccessful due to intra-abdominal adhesions despite being above the level of the incision. 2 right upper quadrant and 1 subcostal 5 mm trochars were inserted using Optiview technique in the insufflated abdomen. Looking at the midline there was extensive adhesions including numerous loops of bowel adhered to the anterior abdominal wall. There is also extensive adhesions in the right upper quadrant to the gallbladder. This began the process of lysis of adhesions which lasted 1 hour. In this time I was able to free up enough adhesions in order to insert a right lower quadrant trocar and get some visualization of the gallbladder. I was also able to free up the adhesions from the undersurface of the gallbladder. It was immediately evident, however, cholecystectomy could not be performed as the gallbladder neck was unable to be visualized. I believe even with an open incision this would have been a very difficult cholecystectomy. Rupture appeared imminent with necrotic gallbladder.
Cholecystostomy tube was placed using a pigtail catheter and placed to suction by JP drain. Bile was removed from the abdomen and the right upper quadrant irrigated. All incisions were 5 mm and inserted bluntly through the Optiview port and so no fascial closure was required. The cholecystostomy tube was sutured in place using 2-0 Prolene suture. All trocar sites were closed using 4-0 Monocryl suture and skin glue.
Operation: Exploratory laparoscopy with extensive lysis of adhesions totaling 1 hour and insertion of cholecystostomy tube under laparoscopic guidance
A 5 mm trocar was attempted to be placed in the upper midline which was ultimately unsuccessful due to intra-abdominal adhesions despite being above the level of the incision. 2 right upper quadrant and 1 subcostal 5 mm trochars were inserted using Optiview technique in the insufflated abdomen. Looking at the midline there was extensive adhesions including numerous loops of bowel adhered to the anterior abdominal wall. There is also extensive adhesions in the right upper quadrant to the gallbladder. This began the process of lysis of adhesions which lasted 1 hour. In this time I was able to free up enough adhesions in order to insert a right lower quadrant trocar and get some visualization of the gallbladder. I was also able to free up the adhesions from the undersurface of the gallbladder. It was immediately evident, however, cholecystectomy could not be performed as the gallbladder neck was unable to be visualized. I believe even with an open incision this would have been a very difficult cholecystectomy. Rupture appeared imminent with necrotic gallbladder.
Cholecystostomy tube was placed using a pigtail catheter and placed to suction by JP drain. Bile was removed from the abdomen and the right upper quadrant irrigated. All incisions were 5 mm and inserted bluntly through the Optiview port and so no fascial closure was required. The cholecystostomy tube was sutured in place using 2-0 Prolene suture. All trocar sites were closed using 4-0 Monocryl suture and skin glue.