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I am just needing help with the ICD 10 PCS procedure for the END colostomy for the following please
this is what i have come up with for the procedures 0DTN0ZZ - Resection of Sigmoid Colon, Open Approach and 0D1N0Z4 - Bypass Sigmoid Colon to Cutaneous, Open Approach
Procedure: Exploratory laparotomy, Sigmoid colectomy with end colostomy
A midline abdominal incision was made inferior from above the umbilicus to the pubic bone. This was carried down bluntly to the level of the facia. The facia was elevated between two Kochers and insised with scissors. The intra-abdominal cavity was directly visualized. The fasia was then opend to the length of the skin incision with care to protect the underlying bowel. The abdomen was explored. There is no obvious free perforation, purulence or contamination or leak contaminating the abdominal cavity. There was quite a bit of induration at the sigmoid and pelvis.
A bookwalter was used for retraction. The small bowel and cecum are gently packed superiorly of the pelvis. The lateral attachments to the sigmoid were taken down with electrocautery and blunt dissection along the peritoneal reflection. This mobilized the descending colon and some of the sigmoid. At the distal descending colon the colon was normal and just into the sigmoid the induration was pronounced. Therefore the distal descending colon was chosen as the proximal transection. This is performed with 75 mm GIA stapler. Thunderbeat is used to divid the sigmoid from the mesentery down to the rectum.
The dissection of the sigmoid was continued down into the pelvis along the abscess. Quite a bit of purulence was evacuated and a culture was taken. The left ureter was quite a bit enlarged as seen on CT scan and was identified and protected. Moving inferiorly and anteriorly the tissue planes were obliterated. Initially it appeared as though there was a fistula into the urinary bladder but the bladder was tested with saline with a three way Foley and there was no obvious leak. The peritoneum medial to the sigmoid and rectum was scored with cautery. The thunder beat device was used to divide the mesentery. The left colic artery was identified and double ligated with 2-0 Vicryl suture ligature and a 2-0 Vicryl tie. It was transected. The dissection continued until distal to the very indurated rectum. The rectum is divided with a Contour Stapler. A silk stitch is placed at distal specimen for orientation and it is passed off for pathology.
Hemostasis is ensured. The proximal sigmoid lays down with out any tension to the proposed ostomy site in the left lower quadrant. A disc of skin was removed from the colostomy site in the left lower quadrant. The incision was deepened through all layers of the abdominal wall and dilated to admit to to 3 fingers. 4 cm of the sigmoid were brought through and cleared the skin at the ostomy site. Care was taken to prevent any torsion or twisting of the bowel. A 15 French round JP drain was placed into the pelvis through a second stab incision and attached the skin with a 3-0 nylon stitch.
Attention was turned to closing the abdomen. 0 PDS was used to close the fascia. A running 3-0 Vicryl was used to close Scarpa's fascia. Interrupted 3-0 Vicryl was used to reapproximate the dermis. The skin was closed with staples. A dressing consisting of Xeroform and gauze was taped in place.
Attention was then turned to the ostomy to be matured. The distal 2-1/2 cm of the colon became somewhat dusky, discolored. The discolored part was removed with scissors and discarded. The remaining stump was briskly bleeding and appeared well perfused. The colostomy was matured with multiple interrupted sutures of 3-0 Vicryl. Mastisol was placed on the skin and then an ostomy appliance was cut to size and placed over the new colostomy.
this is what i have come up with for the procedures 0DTN0ZZ - Resection of Sigmoid Colon, Open Approach and 0D1N0Z4 - Bypass Sigmoid Colon to Cutaneous, Open Approach
Procedure: Exploratory laparotomy, Sigmoid colectomy with end colostomy
A midline abdominal incision was made inferior from above the umbilicus to the pubic bone. This was carried down bluntly to the level of the facia. The facia was elevated between two Kochers and insised with scissors. The intra-abdominal cavity was directly visualized. The fasia was then opend to the length of the skin incision with care to protect the underlying bowel. The abdomen was explored. There is no obvious free perforation, purulence or contamination or leak contaminating the abdominal cavity. There was quite a bit of induration at the sigmoid and pelvis.
A bookwalter was used for retraction. The small bowel and cecum are gently packed superiorly of the pelvis. The lateral attachments to the sigmoid were taken down with electrocautery and blunt dissection along the peritoneal reflection. This mobilized the descending colon and some of the sigmoid. At the distal descending colon the colon was normal and just into the sigmoid the induration was pronounced. Therefore the distal descending colon was chosen as the proximal transection. This is performed with 75 mm GIA stapler. Thunderbeat is used to divid the sigmoid from the mesentery down to the rectum.
The dissection of the sigmoid was continued down into the pelvis along the abscess. Quite a bit of purulence was evacuated and a culture was taken. The left ureter was quite a bit enlarged as seen on CT scan and was identified and protected. Moving inferiorly and anteriorly the tissue planes were obliterated. Initially it appeared as though there was a fistula into the urinary bladder but the bladder was tested with saline with a three way Foley and there was no obvious leak. The peritoneum medial to the sigmoid and rectum was scored with cautery. The thunder beat device was used to divide the mesentery. The left colic artery was identified and double ligated with 2-0 Vicryl suture ligature and a 2-0 Vicryl tie. It was transected. The dissection continued until distal to the very indurated rectum. The rectum is divided with a Contour Stapler. A silk stitch is placed at distal specimen for orientation and it is passed off for pathology.
Hemostasis is ensured. The proximal sigmoid lays down with out any tension to the proposed ostomy site in the left lower quadrant. A disc of skin was removed from the colostomy site in the left lower quadrant. The incision was deepened through all layers of the abdominal wall and dilated to admit to to 3 fingers. 4 cm of the sigmoid were brought through and cleared the skin at the ostomy site. Care was taken to prevent any torsion or twisting of the bowel. A 15 French round JP drain was placed into the pelvis through a second stab incision and attached the skin with a 3-0 nylon stitch.
Attention was turned to closing the abdomen. 0 PDS was used to close the fascia. A running 3-0 Vicryl was used to close Scarpa's fascia. Interrupted 3-0 Vicryl was used to reapproximate the dermis. The skin was closed with staples. A dressing consisting of Xeroform and gauze was taped in place.
Attention was then turned to the ostomy to be matured. The distal 2-1/2 cm of the colon became somewhat dusky, discolored. The discolored part was removed with scissors and discarded. The remaining stump was briskly bleeding and appeared well perfused. The colostomy was matured with multiple interrupted sutures of 3-0 Vicryl. Mastisol was placed on the skin and then an ostomy appliance was cut to size and placed over the new colostomy.