tloeb
Networker
My provider is wanting to bill 49000 & 58925. Because 49000 and a omentectomy 49255 are not allowed with 58925 I wanted to reach out to see if there are other codes that I am overlooking to help account for all of her work as this was not a simple ovarian cystectomy, would the only option be to add modifier 22 to 58925?
OP Detail:
The patient's prior scar was excised with Bovie cautery. The fascia was incised with cautery and extended superiorly and inferiorly. There were dense adhesions between the subcutaneous tissue, fascia, and peritoneum so we carefully proceeded with opening this tissue layer by layer. We entered the peritoneum sharply and extended the peritoneal incision superiorly and inferiorly. Abdominal survey was performed with findings as above.
We divided parasitic vessels between the omentum, the surface of the cyst and the peritoneum with the Enseal. Additional adhesions between the mass and surrounding peritoneum were divided with sharp and blunt dissection. We were able to exteriorize the right ovary. We then proceeded with infracolic omentectomy given the unusual vascularity and appearance of the omentum, consistent with either chronic inflammation, malignancy or potentially endometriosis and sent this for intraoperative pathology.
We then placed the right ovarian cyst in a bag and drained the cyst in a contained manner with minimal spillage outside of the bag. The cyst contained approximately 1.6L of dark yellow/brown fluid with additional more solid components inferiorly. We then clamped across the base of the cyst with Peon clamps and divided the cyst from the remaining underlying ovary with Mayo scissors. This was sent to pathology for intraoperative consult which returned as benign, as did examination of the omentum.
We then inspected the bowel from the ileocecal junction to the ligament of Treitz. There was an additional portion of similar appearing omentum with increased vascularity adherent to a loop of ileum that had hyperpigmented, flat lesions on the mucosa. The omentum was freed from the bowel with blunt dissection and resected with the Enseal. We inspected the ileum and sampled one of the implants. The underlying bowel serosa appeared healthy and well perfused.
We set up the Bookwalter retractor and packed away the large and small bowel. We removed the Pean clamps from the right ovary and removed a small portion of additional cyst contents. A combination of Floseal and Bovie cautery were used to obtain hemostasis in the ovarian cyst bed.
The right pelvic sidewall was then opened beneath the round ligament and we identified the ureter deep in the retroperitoneum. It was vermiculating freely. We then biopsied a hyperpigmented area on the right uterosacral ligament.
The pelvis was irrigated and was hemostatic. Remaining Floseal was placed in the anterior and posterior cul de sac.
OP Detail:
The patient's prior scar was excised with Bovie cautery. The fascia was incised with cautery and extended superiorly and inferiorly. There were dense adhesions between the subcutaneous tissue, fascia, and peritoneum so we carefully proceeded with opening this tissue layer by layer. We entered the peritoneum sharply and extended the peritoneal incision superiorly and inferiorly. Abdominal survey was performed with findings as above.
We divided parasitic vessels between the omentum, the surface of the cyst and the peritoneum with the Enseal. Additional adhesions between the mass and surrounding peritoneum were divided with sharp and blunt dissection. We were able to exteriorize the right ovary. We then proceeded with infracolic omentectomy given the unusual vascularity and appearance of the omentum, consistent with either chronic inflammation, malignancy or potentially endometriosis and sent this for intraoperative pathology.
We then placed the right ovarian cyst in a bag and drained the cyst in a contained manner with minimal spillage outside of the bag. The cyst contained approximately 1.6L of dark yellow/brown fluid with additional more solid components inferiorly. We then clamped across the base of the cyst with Peon clamps and divided the cyst from the remaining underlying ovary with Mayo scissors. This was sent to pathology for intraoperative consult which returned as benign, as did examination of the omentum.
We then inspected the bowel from the ileocecal junction to the ligament of Treitz. There was an additional portion of similar appearing omentum with increased vascularity adherent to a loop of ileum that had hyperpigmented, flat lesions on the mucosa. The omentum was freed from the bowel with blunt dissection and resected with the Enseal. We inspected the ileum and sampled one of the implants. The underlying bowel serosa appeared healthy and well perfused.
We set up the Bookwalter retractor and packed away the large and small bowel. We removed the Pean clamps from the right ovary and removed a small portion of additional cyst contents. A combination of Floseal and Bovie cautery were used to obtain hemostasis in the ovarian cyst bed.
The right pelvic sidewall was then opened beneath the round ligament and we identified the ureter deep in the retroperitoneum. It was vermiculating freely. We then biopsied a hyperpigmented area on the right uterosacral ligament.
The pelvis was irrigated and was hemostatic. Remaining Floseal was placed in the anterior and posterior cul de sac.
