lucianne02
New
Could someone help with a code for this procedure:
patient underwent Cesarean section yesterday. In the evening she began having some increased drainage of fluid shortly before 5 p.m it was blood-tinged and my feeling was that it was a left over-irrigation that was leaking its way out. The dressing was changed and reinforced and then at 0430 today, dressing was sopping wet and had to be changed again and leaking large amounts of the nurse felt to be blood. I evaluated the patient shortly before 7:00, decided with her that we needed to proceed back to the operating room as the differential included just leakage of fluid or some ongoing bleeding though I felt it was more of a blood-tinged water exudate or it was a dehiscence.
I used the Mayo scissors to cut out each of the Insorb subcuticular staples and immediately omentum was visualized. We were not able to visualize the suture that we had placed in the fascia yesterday. There were large amounts of omentum. The 2 interrupted sutures I had placed through the rectus muscle and peritoneum were intact and the bowel and omentum were over the superior edge of this. I left those 2 intraabdominal stitches intact that were loosely reapproximated in the rectus muscle and the peritoneum. We then used a moistened packing and irrigated 2 liters of fluid in and out of the abdomen and pelvis. I was happy that there was no ongoing bleeding internally and after the irrigation, a third stitch to augment the 2 that were placed yesterday through the rectus and peritoneum more superiorly to close that off was performed and then the subcutaneous and fascial tissue was then irrigated. Next, I was standing on the patient's left side and I grasped the left apex of the fascia with Kocher clamps and the assistant on today used the retractors to show me the fascia on the patient's right side. A running simple figure-of-eight stitch #1 Vicryl was placed in the patient's right to left side securely closing the fascia. Next, the subcutaneous tissue was irrigated with an additional 250 to 500 cc of sterile saline. Bovie cautery was used to cauterize any subcuticular bleeding vessels. I irrigated a little bit more. At this point, when I was satisfied with hemostasis, I then closed the skin with the Insorb subcuticular stapler. I then used the Prevena wound VAC over the incision itself and the patient was taken to recovery room in stable condition. She tolerated the procedure well. There was no blood loss, just the peritoneal fluid.
patient underwent Cesarean section yesterday. In the evening she began having some increased drainage of fluid shortly before 5 p.m it was blood-tinged and my feeling was that it was a left over-irrigation that was leaking its way out. The dressing was changed and reinforced and then at 0430 today, dressing was sopping wet and had to be changed again and leaking large amounts of the nurse felt to be blood. I evaluated the patient shortly before 7:00, decided with her that we needed to proceed back to the operating room as the differential included just leakage of fluid or some ongoing bleeding though I felt it was more of a blood-tinged water exudate or it was a dehiscence.
I used the Mayo scissors to cut out each of the Insorb subcuticular staples and immediately omentum was visualized. We were not able to visualize the suture that we had placed in the fascia yesterday. There were large amounts of omentum. The 2 interrupted sutures I had placed through the rectus muscle and peritoneum were intact and the bowel and omentum were over the superior edge of this. I left those 2 intraabdominal stitches intact that were loosely reapproximated in the rectus muscle and the peritoneum. We then used a moistened packing and irrigated 2 liters of fluid in and out of the abdomen and pelvis. I was happy that there was no ongoing bleeding internally and after the irrigation, a third stitch to augment the 2 that were placed yesterday through the rectus and peritoneum more superiorly to close that off was performed and then the subcutaneous and fascial tissue was then irrigated. Next, I was standing on the patient's left side and I grasped the left apex of the fascia with Kocher clamps and the assistant on today used the retractors to show me the fascia on the patient's right side. A running simple figure-of-eight stitch #1 Vicryl was placed in the patient's right to left side securely closing the fascia. Next, the subcutaneous tissue was irrigated with an additional 250 to 500 cc of sterile saline. Bovie cautery was used to cauterize any subcuticular bleeding vessels. I irrigated a little bit more. At this point, when I was satisfied with hemostasis, I then closed the skin with the Insorb subcuticular stapler. I then used the Prevena wound VAC over the incision itself and the patient was taken to recovery room in stable condition. She tolerated the procedure well. There was no blood loss, just the peritoneal fluid.