nlbarnes
Expert
44970 or 44160-52, 44204-52, or 49329?
The surgeon informed me that "44970 - This code is the closest to what I did. The appendix was already out. There was a possible mucocele at the appendix stump so I laparoscopically took off the base of the cecum to include the appendiceal stump. There is no code for this that I am aware of".
PROCEDURE PERFORMED: LAPAROSCOPIC CECECTOMY
A #5 trocar was placed in the
left upper quadrant. #5, 30-degree laparoscope was placed in the
abdomen. There was no evidence of bowel or blood vessel injury.
Under direct vision, #12 trocar was placed in the left mid quadrant,
#5 trocar in the lower midline, and #5 trocar in the right upper
quadrant. The ink placed by the gastroenterologist was immediately
seen in the cecum at a location consistent with the appendiceal stump. The
white line of Toldt on the patient's right side opposite the cecum was taken
down with the #5 EnSeal. Some adhesions of the terminal ileal mesentery to
the sidewall were taken down with a #5 EnSeal. We then grasped the fat pad on
the terminal ileum and held that superiorly so we could see where the terminal
ileum was entering the cecum at the ileocecal valve. We then dissected the
fat off the cecum that was distal and inferior to the ileocecal valve using
the #5 EnSeal to carefully dissect off all this fat taking care to avoid
injury to the bowel itself. Once we had completely cleaned off the
inferior bulb of the cecum at the point we had chosen for division, we then
passed an Endo- GIA 60 blue reticulating stapler and positioned it so that it
was just inferior to the ileocecal valve, so that it should not impinge on the
ileocecal valve, and this definitely also would give us a specimen that would
include all the ink in the specimen, we fired the stapler once and
then we had to fire a second time to come all the way across the cecum
on the lateral side. We then placed the portion of cecum in a plastic bag and
removed it via the left mid quadrant port site. I peeled off the
staple line with the scissor on the back table and everted the
specimen and I was frankly not sure that I could see any actual mass
at the appendiceal stump, but in any case, we have now removed the
area that the gastroenterologist questioned a mass and pathology will
be able to examine it to see if there is indeed any lesion there.
Certainly, there was no obvious cancer and since we felt we had
removed the appendiceal stump with the ink without impinging on the
ileocecal valve, there was no indication at this time for right colectomy.
Hemostasis was achieved with a #5 EnSeal. The right lower quadrant was
irrigated with normal saline. All was dry at closure. The liver appeared
grossly normal in the portions we could see and the gallbladder appeared
normal. The bowel superficially appeared normal. The left mid quadrant 12 port
site was closed with a 0 Vicryl Endo Close. All ports were removed under
613108451 032417
The surgeon informed me that "44970 - This code is the closest to what I did. The appendix was already out. There was a possible mucocele at the appendix stump so I laparoscopically took off the base of the cecum to include the appendiceal stump. There is no code for this that I am aware of".
PROCEDURE PERFORMED: LAPAROSCOPIC CECECTOMY
A #5 trocar was placed in the
left upper quadrant. #5, 30-degree laparoscope was placed in the
abdomen. There was no evidence of bowel or blood vessel injury.
Under direct vision, #12 trocar was placed in the left mid quadrant,
#5 trocar in the lower midline, and #5 trocar in the right upper
quadrant. The ink placed by the gastroenterologist was immediately
seen in the cecum at a location consistent with the appendiceal stump. The
white line of Toldt on the patient's right side opposite the cecum was taken
down with the #5 EnSeal. Some adhesions of the terminal ileal mesentery to
the sidewall were taken down with a #5 EnSeal. We then grasped the fat pad on
the terminal ileum and held that superiorly so we could see where the terminal
ileum was entering the cecum at the ileocecal valve. We then dissected the
fat off the cecum that was distal and inferior to the ileocecal valve using
the #5 EnSeal to carefully dissect off all this fat taking care to avoid
injury to the bowel itself. Once we had completely cleaned off the
inferior bulb of the cecum at the point we had chosen for division, we then
passed an Endo- GIA 60 blue reticulating stapler and positioned it so that it
was just inferior to the ileocecal valve, so that it should not impinge on the
ileocecal valve, and this definitely also would give us a specimen that would
include all the ink in the specimen, we fired the stapler once and
then we had to fire a second time to come all the way across the cecum
on the lateral side. We then placed the portion of cecum in a plastic bag and
removed it via the left mid quadrant port site. I peeled off the
staple line with the scissor on the back table and everted the
specimen and I was frankly not sure that I could see any actual mass
at the appendiceal stump, but in any case, we have now removed the
area that the gastroenterologist questioned a mass and pathology will
be able to examine it to see if there is indeed any lesion there.
Certainly, there was no obvious cancer and since we felt we had
removed the appendiceal stump with the ink without impinging on the
ileocecal valve, there was no indication at this time for right colectomy.
Hemostasis was achieved with a #5 EnSeal. The right lower quadrant was
irrigated with normal saline. All was dry at closure. The liver appeared
grossly normal in the portions we could see and the gallbladder appeared
normal. The bowel superficially appeared normal. The left mid quadrant 12 port
site was closed with a 0 Vicryl Endo Close. All ports were removed under
613108451 032417
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