l1ttle_0ne
Guru
Can anyone help me with the coding for this operative report. The physician put 44207, and 49203. However the 49203 is not laparoscopic. I'm thinking an unlisted code?? Pathology does show it is an endometrial mass that was removed. Any help you can give me would be great. This one is confusing me 
DATE OF PROCEDURE:
PREOP DX: pelvic mass
POSTOP DX: Retained right ovary
Rectosigmoid mass
Anterior rectal mass
SURGEON:
OPERATIVE PROCEDURE:
Laparoscopic, robotic assisted sigmoid resection with coloproctostomy.
Excision of retroperitoneal mass (49203)
FINDINGS: The right ovary vs endometrioma was in the right retroperitoneum; . It was mobilized sharply from the ureter to which it was very adhered. Methylene blue revealed no injury
There was a mass in the sigmoid colon (?diverticulum vs endometrosis); not clear what this is. There is also a second anterior proximal rectal mass. The distal sigmoid colon and proximal rectum were resected, with a stapled, 29 mm end to end anastomosis created that was tension free, had excellent blood supply, and full tissue apposition. Air leak test revealed no leak. There is 7-8 cm of rectum proximal to the anastomosis
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and given general anesthetic. Patient sterilely prepped and draped in the low lithotomy position. Pneumoperitoneum obtained with a verses needle. A 12 mm umbilical (2 cm right lateral and 2 cm cephalod to umbilicus) was placed. This was followed with an 8 mm RLQ port and two 8 mm left lateral port. Using laparoscopic instruments the anatomy was assessed and this patient was deemed to be a good candidate for robotic assistance. A 12 mm RUQ assistant port was placed.
The robot was docked over the left leg. The sigmoid colon was adhered to the vaginal cuff and bladder. It was mobilized sharply until only a cuff of very aderent tissue was left on the vagina. The sigmoid colon was mobilized from the pelvic brim using scissors with electrocautery . The sigmoid colon and descending colon were mobilized from the retroperitoneum along the white line of toldt. The ureter was identified.
The mass on the right retroperitoneum was noted. The peritoneal lining over the mass was incised. The mass was then grasped and gently freed from the retroperitoneum. The ureter was identified and preserved. It was completely freed from the retroperitoneum at this point.
A 6 cm pfannenstiel incision was made. The mass was freed anteriorly from the vagina. The lateral stalks were freed with cautery. A contour stapler was then inserted and the rectum was divided at the rectosigmoid junction. The superior hemorrhoidal arteries were clipped and divided. The colon was then eviscerated. The colon was transected at the sigmoid descending colon junction and a 29 mm anvil head was sewn in place with a 2-0 prolene pursestring suture.
A 29 mm end-to-end anastomosis was created. This was visualised with a rigid sigmoidoscope and tested with air and no leak was noted. Hemostasis was checked throughout the abdomen and noted to be excellent. Antibiotic irrigation placed in pelvis for three minutes. The Pfannenstiel incision was closed with running PDS sutures. Skin was closed with subcuticular sutures followed with glue on skin. No complications.
EBL: 300 ml
SPECIMENS:
Sigmoid colon/proximal rectum
Right retroperitoneal mass
COMPLICATIONS: None.
DATE OF PROCEDURE:
PREOP DX: pelvic mass
POSTOP DX: Retained right ovary
Rectosigmoid mass
Anterior rectal mass
SURGEON:
OPERATIVE PROCEDURE:
Laparoscopic, robotic assisted sigmoid resection with coloproctostomy.
Excision of retroperitoneal mass (49203)
FINDINGS: The right ovary vs endometrioma was in the right retroperitoneum; . It was mobilized sharply from the ureter to which it was very adhered. Methylene blue revealed no injury
There was a mass in the sigmoid colon (?diverticulum vs endometrosis); not clear what this is. There is also a second anterior proximal rectal mass. The distal sigmoid colon and proximal rectum were resected, with a stapled, 29 mm end to end anastomosis created that was tension free, had excellent blood supply, and full tissue apposition. Air leak test revealed no leak. There is 7-8 cm of rectum proximal to the anastomosis
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and given general anesthetic. Patient sterilely prepped and draped in the low lithotomy position. Pneumoperitoneum obtained with a verses needle. A 12 mm umbilical (2 cm right lateral and 2 cm cephalod to umbilicus) was placed. This was followed with an 8 mm RLQ port and two 8 mm left lateral port. Using laparoscopic instruments the anatomy was assessed and this patient was deemed to be a good candidate for robotic assistance. A 12 mm RUQ assistant port was placed.
The robot was docked over the left leg. The sigmoid colon was adhered to the vaginal cuff and bladder. It was mobilized sharply until only a cuff of very aderent tissue was left on the vagina. The sigmoid colon was mobilized from the pelvic brim using scissors with electrocautery . The sigmoid colon and descending colon were mobilized from the retroperitoneum along the white line of toldt. The ureter was identified.
The mass on the right retroperitoneum was noted. The peritoneal lining over the mass was incised. The mass was then grasped and gently freed from the retroperitoneum. The ureter was identified and preserved. It was completely freed from the retroperitoneum at this point.
A 6 cm pfannenstiel incision was made. The mass was freed anteriorly from the vagina. The lateral stalks were freed with cautery. A contour stapler was then inserted and the rectum was divided at the rectosigmoid junction. The superior hemorrhoidal arteries were clipped and divided. The colon was then eviscerated. The colon was transected at the sigmoid descending colon junction and a 29 mm anvil head was sewn in place with a 2-0 prolene pursestring suture.
A 29 mm end-to-end anastomosis was created. This was visualised with a rigid sigmoidoscope and tested with air and no leak was noted. Hemostasis was checked throughout the abdomen and noted to be excellent. Antibiotic irrigation placed in pelvis for three minutes. The Pfannenstiel incision was closed with running PDS sutures. Skin was closed with subcuticular sutures followed with glue on skin. No complications.
EBL: 300 ml
SPECIMENS:
Sigmoid colon/proximal rectum
Right retroperitoneal mass
COMPLICATIONS: None.