Michael0630
New
Hii I just started coding for General Surgery and I am stuck. Can someone provide some assistance?
Would you code this as 47480? Thank you in advance!
Procedure Details:
After informed consent was obtained from patient's wife, the patient was brought to the operating room and placed in the supine position. The appropriate monitors were placed and general anesthesia was induced via endotracheal intubation by anesthesia team uneventfully. Perioperative weight based cefoxitin antibiotic given. The stomach was decompressed with orogastric tube and foley catheter was placed. The abdomen was prepped and draped in the usual sterile fashion. A time out was conducted verifying the correct patient and procedure and, all team members were in agreement.
The abdominal cavity was insufflated to set pneumoperitoneum via Veress needle inserted through 5 mm supraumbilical incision and the abdominal cavity was entered via this port using OptiView. The underlying viscera at the direct point of entry examined and no injury noted. Significantly dilated small and large bowel was found on diagnostic laparoscopy with moderate bilious fluid. At this time, we converted to exploratory laparotomy with midline incision extending from subxiphoid to infraumbilical including the prior 5 mm port incision. Significant bilious fluid drained concerning for bilious peritonitis. Intraperitoneal fluid specimen was sent for culture. Large Alexis wound protector was inserted. Bowel was eviscerated and the gallbladder was noted to be perforated at the infundibulum into the liver with inflammatory hepatic flexure adhesions to the small bowel and colon resulting in significant cecal and ascending colon dilation with hemorrhagic contents. These adhesions were bluntly lysed. There was no safe plane of dissection between the gallbladder and the duodenum, hence subtotal cholecystectomy was performed using top down approach. Upon opening the gallbladder, gallstones were removed and sent as permanent specimen along with partial cholecystectomy. Luminal examination of the remnant gallbladder in the addition gallbladder being fused to the duodenum was concerning for bilioenteric fistula. A 20 Fr Malecot drain was inserted into the remnant gallbladder and secured with #1 Ethibond purse-string stitch. At the time, the intraperitoneal cavity was irrigated with 10 liter of normal saline until clear drainage. The bowel was then ran from terminal ileum to ligament of Treitz milking the stool and hemorrhagic content into the distal colon. No serosal injury or areas of overt ischemia found. Cecum and bowel still noted to be distended but lesser in extend compared to at the beginning of the case. 10 fr Blake drain x 2 were placed in subphrenic area above and below the subtotal cholecystectomy site. Given bowel dilation with significant abdominal edema and patient's unstable hemodynamic status in the setting of known pulmonary hypertension, abdomen was left open with Abthera vac coverage.
Would you code this as 47480? Thank you in advance!
Procedure Details:
After informed consent was obtained from patient's wife, the patient was brought to the operating room and placed in the supine position. The appropriate monitors were placed and general anesthesia was induced via endotracheal intubation by anesthesia team uneventfully. Perioperative weight based cefoxitin antibiotic given. The stomach was decompressed with orogastric tube and foley catheter was placed. The abdomen was prepped and draped in the usual sterile fashion. A time out was conducted verifying the correct patient and procedure and, all team members were in agreement.
The abdominal cavity was insufflated to set pneumoperitoneum via Veress needle inserted through 5 mm supraumbilical incision and the abdominal cavity was entered via this port using OptiView. The underlying viscera at the direct point of entry examined and no injury noted. Significantly dilated small and large bowel was found on diagnostic laparoscopy with moderate bilious fluid. At this time, we converted to exploratory laparotomy with midline incision extending from subxiphoid to infraumbilical including the prior 5 mm port incision. Significant bilious fluid drained concerning for bilious peritonitis. Intraperitoneal fluid specimen was sent for culture. Large Alexis wound protector was inserted. Bowel was eviscerated and the gallbladder was noted to be perforated at the infundibulum into the liver with inflammatory hepatic flexure adhesions to the small bowel and colon resulting in significant cecal and ascending colon dilation with hemorrhagic contents. These adhesions were bluntly lysed. There was no safe plane of dissection between the gallbladder and the duodenum, hence subtotal cholecystectomy was performed using top down approach. Upon opening the gallbladder, gallstones were removed and sent as permanent specimen along with partial cholecystectomy. Luminal examination of the remnant gallbladder in the addition gallbladder being fused to the duodenum was concerning for bilioenteric fistula. A 20 Fr Malecot drain was inserted into the remnant gallbladder and secured with #1 Ethibond purse-string stitch. At the time, the intraperitoneal cavity was irrigated with 10 liter of normal saline until clear drainage. The bowel was then ran from terminal ileum to ligament of Treitz milking the stool and hemorrhagic content into the distal colon. No serosal injury or areas of overt ischemia found. Cecum and bowel still noted to be distended but lesser in extend compared to at the beginning of the case. 10 fr Blake drain x 2 were placed in subphrenic area above and below the subtotal cholecystectomy site. Given bowel dilation with significant abdominal edema and patient's unstable hemodynamic status in the setting of known pulmonary hypertension, abdomen was left open with Abthera vac coverage.