herrera4
Guru
If an excision of an ectopic liver is performed with a lap cholecystecomy-can it be billed separately? or is this bundled? thank you
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Wiki ecoptic liver
- Thread starter herrera4
- Start date
colorectal surgeon
Guest
please post the scrubbed op note
herrera4
Guru
....... There were some supraumbilical adhesions from a previous splenectomy but the right upper quadrant was free of adhesions. 12 mm epigastric, two 5 mm lateral ports were placed. The gallbladder was grasped, elevated over the dome of the liver. There were some chronic adhesions that were filmy to the gallbladder but these were not too much of an issue. The neck of the gallbladder was identified, freed from surrounding tissue. The cystic duct was freed off. It was partially transected after a clip was placed on the gallbladder side. Cholangiogram catheter easily passed into the cystic duct. It was clipped into place. A cholangiogram was performed which showed good filling of the common bile duct, left and right hepatic ducts, common hepatic duct, the common bile duct. There was good flow into the duodenum. The pancreatic duct partially filled. There was no obvious filling defect noted at this time. This was confirmed by the radiologist.
The cholangiogram catheter was removed. The gallbladder was clipped three times and transected. The cystic artery was identified, clipped and divided. The gallbladder was removed from the liver bed using electrocautery. There was a reddish maroon solid piece what appeared to be liver adherent to the gallbladder which seemed to be distinct from the liver. The question was could this be an ectopic spleen from her previous splenectomy or if it was an ectopic piece of liver; nonetheless, it was attached to the gallbladder so it was excised with the gallbladder. The gallbladder was completely removed from the liver bed. It was brought out through an endo-retrieval bag through the infraumbilical port site. The ports were replaced. Abdomen was reinsufflated. The area was irrigated and suctioned free. There was no leakage of blood or bile. The clips were inspected. All the clips were intact. All the ports were taken out under direct vision. The infraumbilical port site was closed with interrupted figure-of-eight 0 Vicryl stitch. All the skin incisions were closed with running subcuticular 4-0 Monocryl stitch reinforced with Steri-Strips. The patient tolerated the procedure well and was brought to the recovery room in satisfactory condition.
PATH REPORT
B. Labeled Liver Biopsy. The specimen consists of a 2.2 x 1.1 x 0.5 cm portion
of liver predominately surfaced by a glistening capsule. The margin is inked
and sectioning reveals a soft tan-green parenchyma. Entire specimen submitted
in cassette B.
thank u
The cholangiogram catheter was removed. The gallbladder was clipped three times and transected. The cystic artery was identified, clipped and divided. The gallbladder was removed from the liver bed using electrocautery. There was a reddish maroon solid piece what appeared to be liver adherent to the gallbladder which seemed to be distinct from the liver. The question was could this be an ectopic spleen from her previous splenectomy or if it was an ectopic piece of liver; nonetheless, it was attached to the gallbladder so it was excised with the gallbladder. The gallbladder was completely removed from the liver bed. It was brought out through an endo-retrieval bag through the infraumbilical port site. The ports were replaced. Abdomen was reinsufflated. The area was irrigated and suctioned free. There was no leakage of blood or bile. The clips were inspected. All the clips were intact. All the ports were taken out under direct vision. The infraumbilical port site was closed with interrupted figure-of-eight 0 Vicryl stitch. All the skin incisions were closed with running subcuticular 4-0 Monocryl stitch reinforced with Steri-Strips. The patient tolerated the procedure well and was brought to the recovery room in satisfactory condition.
PATH REPORT
B. Labeled Liver Biopsy. The specimen consists of a 2.2 x 1.1 x 0.5 cm portion
of liver predominately surfaced by a glistening capsule. The margin is inked
and sectioning reveals a soft tan-green parenchyma. Entire specimen submitted
in cassette B.
thank u
mitchellde
True Blue
no it cannot be billed separate as a separate excision was not performed. The note states a "maroon solid piece what appeared to be liver adherent to the gallbladder" , the surgeon is not certain it was a piece of the liver and speculates it could have been a part of the spleen. At any rate it was attached to the gallbladder and was not excised as a separate procedure , therefore a separate procedure may not be billed.