Wiki Eploratory Laparotomy with Revision of Anastomosis

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Nwright73

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Pt 1: Original surgery: Lap rt hemicolectomy, 2 days later had to take pt back and resection and revise the Anastomosis.

Pt 2: Original surgery: Lap Sigmoid Colectomy, 2 days later had to take back for revision of Anastomosis.

What would the CPT codes for this?
 
Can you give more details in regards to what was done during the "revision"? Did the surgeon have to resect any of the ends of the anastamosis?

-Judy Haroon, RN, CPC, CGSC
 
Pt 1: The staples were removed and his abdomen was prepped and draped in a sterile surgical fashion. The old Laparoscopy incisions were reopened and ports were placed again. A camera and 1 instrument were placed into the abdomen after insufflation was done, and enteric contents were noted along the right gutter. The anastomosis was identified and a small 2 mm leak was identified at the edge of the small intestine staple line. The abdomen was deflated, and the right upper quadrant incision was reopened and made just slightly larger by about 2 cm. Dissection again through the tissue was done with cautery and the peritoneum was entered. The bowel was then pulled through the opening and the bowel clamps were placed on the traverse colon, as well as the terminal ileum. Both colon and small bowel were again transected with a 75 mm stapler, and then another side to side anastomosis was done with staples.
 
PT 2: The midline incision was made with a 10 blade and dissection was taken down with cautery down the linea alba which was opened. The peritoneum was entered. There was a small amount of serous fluid. No enteric content was identified. The bowel was placed and the abdominal wall was retracted. The small bowel was tucked up into the right and left upper quadrants and the anastomosis was identified. There was a small leak identified laterally on the lateral aspect of the anastomosis. A contour stapler was then used to staple either side of the anastomosis removing the anastomosis. The rectum was then grasped with a straight colon clamp as well as the descending colon, and the staple lines were opened. The anvil of a 29 mm stapler was placed into the rectum and secured with 2-0 prolene, closing the rectum around the anvil and keeping it in place. An enterotomy was made into the descending colon, and the round stapler was placed through that and the anastomosis was fired. The donut was inspected and and there was an area where it was very thing. And,therefore, the anastomosis was inspected, and the area of weakness was identified and it was opened and closed with 2-0 Vicryl and then the entire circumference of the anastomosis was reinforced with 2-0 silk pop-offs. The enterotomy in the descending colon was closed with Vicryl and silk pop-offs.
 
Part 2 is a little tricky... I want to say 44145-78. Doc says "anastamosis was fired". Not clear on whether or not any bowel was removed during this. If so, I would code as this. If not, then do not use this code.
 
Thank you, I was thinking the same thing, I just wanted to make sure I was thinking correctly, coding while sick is not a good thing. Thank you for your help
 
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