rrrobinson05
Contributor
Looking for help in coding this surgery....any advice/insight would be sincerely appreciated.
I'm looking at CPT code 44205.
Procedure Performed: Diagnostic laparoscopy, laparoscopic reduction of ileocolonic intussusception, laparoscopic ileocecectomy
Indications: (Patient) is a 3 m.o. male with multiple days of crampy abdominal pain that worsened over the past day. He was seen at (hospital) and u/s and CT were consistent with ileocolonic intussusception with concern for an enteric duplication cyst as a lead point. No bloody bowel movements. The patient was stable and non peritonitic. The patient was then indicated for surgical reduction and likely bowel resection of an enteric duplication cyst. The risks and benefits of the procedure were discussed with the parents who agreed to proceed.
Patient Weight: Weight: 13.7 kg (30 lb 3.3 oz)
Findings: Ileocolonic intussusception reduced without difficulty. Cecal duplication cyst as a lead point. Ileocecectomy completed with stapled side to side, functional end to end anastomosis.
Procedural Details: The patient was identified in the preop area. The patient was brought to the operative suite and placed in the supine position. General anesthesia was induced. Zosyn was administered for antibiotic prophylaxis. A crede maneuver was performed to decompress the urinary bladder which also may have partially reduced the intussusception. The abdomen was then prepped with chlorhexidine and draped in usual sterile fashion. A time out was performed to verify correct patient, diagnosis, procedure, equipment and personnel. No concerns were raised.
An #11 blade was used to make a vertical incision through the umbilicus. A small patent umbilical ring was identified and a hemostat was used to enter the peritoneal cavity. A 12 mm trocar was then placed. Intraabdominal location was confirmed with the laparoscope. The abdomen was insufflated to 15 mm Hg. The laparoscope was inserted and on inspection of the abdomen there was no evidence of bowel or surrounding organ injury from port placement. 2 additional 5 mm ports were placed in the left side of the abdomen. This was done under direct vision and without damage to intra abdominal structure.
Blunt dissection was used to free the omentum from the right side of the abdomen. There remained a small amount of ileum intussuscepting into the right colon. The was gently reduced with laparoscopic graspers without issue. The terminal ileum was woody and inflamed but all the bowel appeared pink and well perfused. The appendix was slightly inflamed. Attachments of the cecum to the sidewall and retroperitoneum were divided bluntly. The cecum and right colon were mobilized from the sidewall and retroperitoneum bluntly. The appendix was then grasped to be eventually externalized through the umbilical defect.
The abdomen was de insufflated and the umbilical incision was slightly enlarged. The fascia was incised approximately 5 mm in both directions. The appendix was then delivered out of the umbilical incision. The cecum and terminal ileum were delivered after some more gentle dissection. The small bowel was ran, no abnormalities including apparent duplication cysts or diverticulum were present. The cecum was palpated and there was a cystic structure palpable in the cecum near the level of the ileocecal valve. Given this finding an ileocecectomy was indicated. A window was created in the mesentery at a healthy location of the ileum approximately 6 cm from the ileocecal valve. The bowel was transected with an endoGIA stapler. The ascending colon was similarly transected. The mesentery of the specimen was ligated with 2-0 silk ties and the specimen was removed. On the back table it was eventually opened and showed a cecal duplication, consistent with preoperative imaging and what was palpable on external examination. The specimen was sent to pathology.
A stapled side to side, functional end to end ileocolonic anastomosis was then completed. The edges of the transected bowel were approximated with a 4-0 vicryl stay sutures. The colon was cleared of some overlying epiploic fat where the staple line was to be placed. The corners of the staple lines were cut off and the 45 mm endoGIA staple load was placed within the bowel lumens and the anastomosis was completed. The staple line was intact and hemostatic. The common enterotomy was then closed with a TA stapler, ensuring no ovelrying staple lines. The staple lines were reinforced with 4-0 vicryl lembert sutures. An additional 4-0 vicryl was placed at the distal end of the anastomotic staple line as a crotch reinforcing suture. The mesenteric defect was closed with 4-0 vicryl. The anastomosis was patent and without any evidence of leak as air and a small amount of succus was moved across. The bowel was replaced within the abdomen.
The umbilical fascia was then closed with an 0 vicryl suture in a continuous manner. Local anesthetic was injected. The skin at each incision was approximated with a 5-0 monocryl. The incisions were cleaned and dried. Dermabond was placed on to the incisions.
I'm looking at CPT code 44205.
Procedure Performed: Diagnostic laparoscopy, laparoscopic reduction of ileocolonic intussusception, laparoscopic ileocecectomy
Indications: (Patient) is a 3 m.o. male with multiple days of crampy abdominal pain that worsened over the past day. He was seen at (hospital) and u/s and CT were consistent with ileocolonic intussusception with concern for an enteric duplication cyst as a lead point. No bloody bowel movements. The patient was stable and non peritonitic. The patient was then indicated for surgical reduction and likely bowel resection of an enteric duplication cyst. The risks and benefits of the procedure were discussed with the parents who agreed to proceed.
Patient Weight: Weight: 13.7 kg (30 lb 3.3 oz)
Findings: Ileocolonic intussusception reduced without difficulty. Cecal duplication cyst as a lead point. Ileocecectomy completed with stapled side to side, functional end to end anastomosis.
Procedural Details: The patient was identified in the preop area. The patient was brought to the operative suite and placed in the supine position. General anesthesia was induced. Zosyn was administered for antibiotic prophylaxis. A crede maneuver was performed to decompress the urinary bladder which also may have partially reduced the intussusception. The abdomen was then prepped with chlorhexidine and draped in usual sterile fashion. A time out was performed to verify correct patient, diagnosis, procedure, equipment and personnel. No concerns were raised.
An #11 blade was used to make a vertical incision through the umbilicus. A small patent umbilical ring was identified and a hemostat was used to enter the peritoneal cavity. A 12 mm trocar was then placed. Intraabdominal location was confirmed with the laparoscope. The abdomen was insufflated to 15 mm Hg. The laparoscope was inserted and on inspection of the abdomen there was no evidence of bowel or surrounding organ injury from port placement. 2 additional 5 mm ports were placed in the left side of the abdomen. This was done under direct vision and without damage to intra abdominal structure.
Blunt dissection was used to free the omentum from the right side of the abdomen. There remained a small amount of ileum intussuscepting into the right colon. The was gently reduced with laparoscopic graspers without issue. The terminal ileum was woody and inflamed but all the bowel appeared pink and well perfused. The appendix was slightly inflamed. Attachments of the cecum to the sidewall and retroperitoneum were divided bluntly. The cecum and right colon were mobilized from the sidewall and retroperitoneum bluntly. The appendix was then grasped to be eventually externalized through the umbilical defect.
The abdomen was de insufflated and the umbilical incision was slightly enlarged. The fascia was incised approximately 5 mm in both directions. The appendix was then delivered out of the umbilical incision. The cecum and terminal ileum were delivered after some more gentle dissection. The small bowel was ran, no abnormalities including apparent duplication cysts or diverticulum were present. The cecum was palpated and there was a cystic structure palpable in the cecum near the level of the ileocecal valve. Given this finding an ileocecectomy was indicated. A window was created in the mesentery at a healthy location of the ileum approximately 6 cm from the ileocecal valve. The bowel was transected with an endoGIA stapler. The ascending colon was similarly transected. The mesentery of the specimen was ligated with 2-0 silk ties and the specimen was removed. On the back table it was eventually opened and showed a cecal duplication, consistent with preoperative imaging and what was palpable on external examination. The specimen was sent to pathology.
A stapled side to side, functional end to end ileocolonic anastomosis was then completed. The edges of the transected bowel were approximated with a 4-0 vicryl stay sutures. The colon was cleared of some overlying epiploic fat where the staple line was to be placed. The corners of the staple lines were cut off and the 45 mm endoGIA staple load was placed within the bowel lumens and the anastomosis was completed. The staple line was intact and hemostatic. The common enterotomy was then closed with a TA stapler, ensuring no ovelrying staple lines. The staple lines were reinforced with 4-0 vicryl lembert sutures. An additional 4-0 vicryl was placed at the distal end of the anastomotic staple line as a crotch reinforcing suture. The mesenteric defect was closed with 4-0 vicryl. The anastomosis was patent and without any evidence of leak as air and a small amount of succus was moved across. The bowel was replaced within the abdomen.
The umbilical fascia was then closed with an 0 vicryl suture in a continuous manner. Local anesthetic was injected. The skin at each incision was approximated with a 5-0 monocryl. The incisions were cleaned and dried. Dermabond was placed on to the incisions.
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