The surgeon feels this partial colectomy with anastomosis should be coded as a laparoscopic procedure, but I think it should be coded as an open one. Just curious what any one else would think & why. Thanks!
"After the induction of general anesthesia, the abdomen was sterilely prepped and draped. A stab incision made in his RUQ. The 12 mm Xcel port was passed under visualization. The abdomen was insufflated to 15 mmHg of CO2 gas. Two additional bladeless ports were placed in the left lower quadrant of the abdomen and to the left of the umbilicus. Using the harmonic scalpel and cautery, the terminal ileum, ascending colon and hepatic flexure were mobilized. The port in the right upper quadrant of the abdomen was removed and the port site extended to the right dividing the full thickness of the abdominal wall. The ascending colon was delivered out through this defect. The distal ileum was divided with blue GIA-75 stapler. The proximal transverse colon divided with blue GIA-75 stapler. The mesentery was mobilized up and off the duodenum. The mesentery was divided with the harmonic scalpel down to the primary vascular pedicle. This was clamped. I then over sewed the pedicle with the silk suture. I elected to create a stapled side-to-side functional end-to-end anastomosis. The common channel was created with a blue GIA-75 stapler. Common enterotomy was closed with TA-60 stapler. Mesenteric defect closed with running silk suture. There was no bleeding from the operative sites. The anastomosis had no tension on it. The anastomosis was placed back in the right upper abdomen. Greater omentum draped across the anastomosis in the small bowel. The patient's anterior and posterior rectus sheaves were closed with a running 1 PDS suture. Skin was closed. Experel was infiltrated into the abdominal wall around the extraction incision. Dry dressing was applied. Patient was extubated in the operating room and transferred to recovery room in stable condition."
"After the induction of general anesthesia, the abdomen was sterilely prepped and draped. A stab incision made in his RUQ. The 12 mm Xcel port was passed under visualization. The abdomen was insufflated to 15 mmHg of CO2 gas. Two additional bladeless ports were placed in the left lower quadrant of the abdomen and to the left of the umbilicus. Using the harmonic scalpel and cautery, the terminal ileum, ascending colon and hepatic flexure were mobilized. The port in the right upper quadrant of the abdomen was removed and the port site extended to the right dividing the full thickness of the abdominal wall. The ascending colon was delivered out through this defect. The distal ileum was divided with blue GIA-75 stapler. The proximal transverse colon divided with blue GIA-75 stapler. The mesentery was mobilized up and off the duodenum. The mesentery was divided with the harmonic scalpel down to the primary vascular pedicle. This was clamped. I then over sewed the pedicle with the silk suture. I elected to create a stapled side-to-side functional end-to-end anastomosis. The common channel was created with a blue GIA-75 stapler. Common enterotomy was closed with TA-60 stapler. Mesenteric defect closed with running silk suture. There was no bleeding from the operative sites. The anastomosis had no tension on it. The anastomosis was placed back in the right upper abdomen. Greater omentum draped across the anastomosis in the small bowel. The patient's anterior and posterior rectus sheaves were closed with a running 1 PDS suture. Skin was closed. Experel was infiltrated into the abdominal wall around the extraction incision. Dry dressing was applied. Patient was extubated in the operating room and transferred to recovery room in stable condition."