amanda19791
Networker
Need advice for division of abdominal fascia for relief of ischemic bowel and temporary closure of gastroschisis with silo. My provider used 49605. Patient had the placement of silo on 8/7 and temporary closure with silo on 8/8. Just trying to figure if I code a post-op visit or 49605 with 58 modifier.
ICD-10:
Gastroschisis with ischemic bowel(Q79.3)
Operative findings: The entirety of the small bowel appeared dusky and ischemic with slight "pinking" of the bowel after relief of pressure at the abdominal wall opening. Interestingly, the bowel under the abdominal wall defect within the abdominal cavity also appeared ischemic though not as dilated as the bowel that was external. Ischemia that could affect bowel not compromised by the abdominal wall opening may make more sense of liver enzymes over 1200, consistent with liver injury potentially from ischemia.
Details of procedure: The patient was placed in the supine position. Adequate anesthesia was induced. The patient was sterilely prepped and draped in a standard fashion. The abdominal fascia was divided inferiorly in the midline. This allowed some relief of the constricting abdominal wall at the base of the silo. However, I was not completely satisfied with this maneuver. The silo was removed (formerly a 4 cm silo), and the bowel was examined. The external bowel was noted to be dilated and ischemic. This seemed to be more so than just prior to the operation. In fact, it seemed at first to progress in its duskiness after release of the fascia. The fascia was further divided superiorly in the midline. The bowel inside the abdominal cavity was examined. Bowel that was within the abdominal cavity not constricted by the abdominal wall defect was noted to also be ischemic without the dilation that was noted in the external bowel. After further observation, the bowel began to show some signs of return to blood flow demonstrating a more red appearance or "pinking" of the bowel. The bowel was replaced within a 5 cm silo, allowing for better retention of the abdominal wall defect to avoid constriction of the bowel. The procedure was well tolerated, and there were no complications.
ICD-10:
Gastroschisis with ischemic bowel(Q79.3)
Operative findings: The entirety of the small bowel appeared dusky and ischemic with slight "pinking" of the bowel after relief of pressure at the abdominal wall opening. Interestingly, the bowel under the abdominal wall defect within the abdominal cavity also appeared ischemic though not as dilated as the bowel that was external. Ischemia that could affect bowel not compromised by the abdominal wall opening may make more sense of liver enzymes over 1200, consistent with liver injury potentially from ischemia.
Details of procedure: The patient was placed in the supine position. Adequate anesthesia was induced. The patient was sterilely prepped and draped in a standard fashion. The abdominal fascia was divided inferiorly in the midline. This allowed some relief of the constricting abdominal wall at the base of the silo. However, I was not completely satisfied with this maneuver. The silo was removed (formerly a 4 cm silo), and the bowel was examined. The external bowel was noted to be dilated and ischemic. This seemed to be more so than just prior to the operation. In fact, it seemed at first to progress in its duskiness after release of the fascia. The fascia was further divided superiorly in the midline. The bowel inside the abdominal cavity was examined. Bowel that was within the abdominal cavity not constricted by the abdominal wall defect was noted to also be ischemic without the dilation that was noted in the external bowel. After further observation, the bowel began to show some signs of return to blood flow demonstrating a more red appearance or "pinking" of the bowel. The bowel was replaced within a 5 cm silo, allowing for better retention of the abdominal wall defect to avoid constriction of the bowel. The procedure was well tolerated, and there were no complications.