clegrand
Contributor
I am questioning the CPT(s) for this surgery...Is it possible to bill both 52353 and 52315 or is CPT 52353 the only thing we can bill?? Any help would be greatly appreciated!
PREOPERATIVE DIAGNOSES:
1. Vaginal suspension mesh erosion into the urethra.
2. Calcified mesh.
3. Urethral calculus.
POSTOPERATIVE DIAGNOSES:
1. Vaginal suspension mesh erosion into the urethra.
2. Calcified mesh.
3. Urethral calculus.
PROCEDURES: Cystoscopy, laser lithotripsy of urethral calculus and
calcified mesh with excision and extraction of mesh particles.
DRAINS: A 20-French Foley catheter.
PROCEDURE IN DETAIL: She was brought into the operating room, placed in
supine position. She underwent general anesthesia. She was placed in
dorsal lithotomy position, prepped and draped in normal sterile fashion.
A 25-French rigid cystoscope was now inserted in the bladder and
cystoscopy performed. Cystoscopy reveals a bladder with no
trabeculation or lesion. The ureteral orifices appeared normal. As you
withdrawn the urethra, however, there is a large 1 cm urethral stone,
which appears adherent to some mesh material. There is also an entire
length of calcification along the urethra, which I suspect is mesh as
well.
A 1000 nm laser fiber was inserted through the cystoscope and placed
against the stone. At a setting of 20 watts, the stone was now
fragmented into multiple pieces. I then fragmented the calcified mesh
and was able to free up all the calcium from the mesh and expose the
mash. I tried to dissect the mesh away from the wall, however, it is
densely adhesed almost cement like. Any free fragments I was able to
remove, I transected with the scissors and extracted, but there is a
segment of approximately a centimeter along the right lateral wall of
the urethra, which is densely adherent, and cannot be removed.
Cystoscopy was repeated. The Ellik evacuator was utilized to remove all
stone pieces from the bladder. At the end of this procedure, there was
no evidence of any remaining foreign body in the bladder. There was no
perforation or injury to the bladder. There was some small bleeding at
the urethra where the laser had been utilized near the bladder neck and
Bugbee cautery was utilized to fulgurate those points. There was no
free mesh seen that was free that would be a source for incrustation.
However, there is definitely at least 1 cm of mesh still adherent to the
wall, which is exposed that certainly could serve as a site for further
encrustation.
At the end the procedure, a 20-French Foley catheter was inserted in the
bladder. The patient was awakened in the operating room, taken to
recovery room in excellent condition.
PLAN: The patient will remain on Cipro 500 mg b.i.d. I have provided
with Percocet for pain. Catheter will remain until next week. The
patient may need to be seen at a tertiary care facility to discuss
further intervention for the urethra.
PREOPERATIVE DIAGNOSES:
1. Vaginal suspension mesh erosion into the urethra.
2. Calcified mesh.
3. Urethral calculus.
POSTOPERATIVE DIAGNOSES:
1. Vaginal suspension mesh erosion into the urethra.
2. Calcified mesh.
3. Urethral calculus.
PROCEDURES: Cystoscopy, laser lithotripsy of urethral calculus and
calcified mesh with excision and extraction of mesh particles.
DRAINS: A 20-French Foley catheter.
PROCEDURE IN DETAIL: She was brought into the operating room, placed in
supine position. She underwent general anesthesia. She was placed in
dorsal lithotomy position, prepped and draped in normal sterile fashion.
A 25-French rigid cystoscope was now inserted in the bladder and
cystoscopy performed. Cystoscopy reveals a bladder with no
trabeculation or lesion. The ureteral orifices appeared normal. As you
withdrawn the urethra, however, there is a large 1 cm urethral stone,
which appears adherent to some mesh material. There is also an entire
length of calcification along the urethra, which I suspect is mesh as
well.
A 1000 nm laser fiber was inserted through the cystoscope and placed
against the stone. At a setting of 20 watts, the stone was now
fragmented into multiple pieces. I then fragmented the calcified mesh
and was able to free up all the calcium from the mesh and expose the
mash. I tried to dissect the mesh away from the wall, however, it is
densely adhesed almost cement like. Any free fragments I was able to
remove, I transected with the scissors and extracted, but there is a
segment of approximately a centimeter along the right lateral wall of
the urethra, which is densely adherent, and cannot be removed.
Cystoscopy was repeated. The Ellik evacuator was utilized to remove all
stone pieces from the bladder. At the end of this procedure, there was
no evidence of any remaining foreign body in the bladder. There was no
perforation or injury to the bladder. There was some small bleeding at
the urethra where the laser had been utilized near the bladder neck and
Bugbee cautery was utilized to fulgurate those points. There was no
free mesh seen that was free that would be a source for incrustation.
However, there is definitely at least 1 cm of mesh still adherent to the
wall, which is exposed that certainly could serve as a site for further
encrustation.
At the end the procedure, a 20-French Foley catheter was inserted in the
bladder. The patient was awakened in the operating room, taken to
recovery room in excellent condition.
PLAN: The patient will remain on Cipro 500 mg b.i.d. I have provided
with Percocet for pain. Catheter will remain until next week. The
patient may need to be seen at a tertiary care facility to discuss
further intervention for the urethra.