Jenetteis
Networker
My surgeon removed a migrated IUD laparoscopically after removing a left ovarian ectopic pregnancy. There isn't a CPT code for LSC, Removal of Migrated IUD, so my codes are 59151, 49329, 59. What CPT code would I use to compare the work to the 49329 unlisted code? Thank you in advance!
DIAGNOSTIC LAPAROSCOPY, REMOVAL OF HEMATOMA OF PERITONEUM, REMOVAL OF LEFT OVARIAN ECTOPIC PREGNANCY, RETROPERITONEUM DISSECTION, REMOVAL OF IUD (L) Operative Note
Diagnosis
Pre-Operative Diagnoses:
1. Ruptured ectopic pregnancy
2. Hemoperitoneum
3. Syncope
4. Acute blood loss anemia
5. Hx of IUD migration
Post-Operative Diagnoses:
1. Same as pre-operative diagnoses
2. Left ovarian ruptured ectopic pregnancy
3. Mirena IUD in retroperitoneum of right lateral abdominal wall
Procedures
Procedures: DIAGNOSTIC LAPAROSCOPY, REMOVAL OF HEMATOMA OF PERITONEUM, REMOVAL OF LEFT OVARIAN ECTOPIC PREGNANCY, RETROPERITONEUM DISSECTION, REMOVAL OF IUD (L)
Surgeons / Assistants
* Dr. M - Primary
* Dr.- Assisting
No Assistants
Procedure Summary
Anesthesia: General ASA: ASA status not filed in the log.
Estimated Blood Loss: 100mL
Drains: [REMOVED] Urethral Catheter Latex 16 Fr (Removed)
Specimens:
LEFT OVARIAN ECTOPIC PREGNANCY
IUD - GROSS ONLY
Implants:
See Intraoperative Record
Indications: 31 y.o. female who is having a procedure for ruptured ectopic pregnancy.
Procedure Details:
Once the informed consent was reviewed, the patient was taken to the operating room where general anesthesia was given. She was then placed in the dorsal lithotomy position and prepped and draped in the usual sterile fashion. A vaginal sponge stick and a foley catheter were placed. Antibiotic prophylaxis was not indicated.
Pneumoperitoneum was established at the umbilicus with a Veress needle up to 15 mmHg, opening pressure was 5mmHg. A 5 mm incision was then created in the umbilicus and a 5-mm bladeless optical dilating trocar was placed without complications. Under direct vision, with care to locate the inferior epigastric arteries, 5-mm ports were placed in the right lower and mid quadrants and left lower quadrant. All incisions were anesthetized with 0.5% Marcaine without epinephrine prior trochar placement.
The patient was then placed into steep trendelenberg. The pelvis and abdomen were surveyed with the findings noted above.
The left ovarian ectopic pregnancy was identified. Using a Maryland Ligasure device, the ectopic products of conception were sharply dissected from the ovarian stroma. A 5mm endocatch bag was introduced into the abdomen and the ectopic products of conception were placed inside. Further blunt and sharp dissection of the left ovary was performed to remove as much ectopic tissue as possible. The endocatch bag was removed and ectopic products were send for permanent histological specimen.
Attention was turned to the migrated IUD located at the right lateral abdominal wall. The peritoneum overlying the IUD was incised. Using blunt dissection, the IUD was teased out of the capsule and retroperitoneal space with care to avoid surrounding anatomical structures. The IUD was removed intact and placed in a 5mm endocatch bag. The bag was removed and IUD was sent for gross specimen.
Irrigation was performed. The pelvis was inspected. Hemostasis was obtained at the surgical pedicles with gentle monopolar coagulation and application of Arista hemostatic snow.
The instruments were then removed and the gas was allowed to escape fully. The trocars were removed, and the skin incisions were closed with 4-0 Monocryl in a subcuticular fashion and covered with Dermabond.
Final sponge, needle, and instrument counts were correct at the completion of the procedure. The foley catheter and vaginal sponge stick were removed. Patient was then awakened and taken to postanesthesia care unit in stable condition.
Findings:
1. Ruptured bleeding left ovarian ectopic pregnancy, removed mostly intact with remaining small tissue removed separately
2. Large blood and clot in the pelvis upon entry, total 600mL
3. Mirena IUD encapsulated in the retroperitoneum of the right lateral abdominal wall adjacent to the terminal ileum, appendix, and ascending colon; removed intact
3. Hemostatic surgical pedicles at conclusion of procedure
DIAGNOSTIC LAPAROSCOPY, REMOVAL OF HEMATOMA OF PERITONEUM, REMOVAL OF LEFT OVARIAN ECTOPIC PREGNANCY, RETROPERITONEUM DISSECTION, REMOVAL OF IUD (L) Operative Note
Diagnosis
Pre-Operative Diagnoses:
1. Ruptured ectopic pregnancy
2. Hemoperitoneum
3. Syncope
4. Acute blood loss anemia
5. Hx of IUD migration
Post-Operative Diagnoses:
1. Same as pre-operative diagnoses
2. Left ovarian ruptured ectopic pregnancy
3. Mirena IUD in retroperitoneum of right lateral abdominal wall
Procedures
Procedures: DIAGNOSTIC LAPAROSCOPY, REMOVAL OF HEMATOMA OF PERITONEUM, REMOVAL OF LEFT OVARIAN ECTOPIC PREGNANCY, RETROPERITONEUM DISSECTION, REMOVAL OF IUD (L)
Surgeons / Assistants
* Dr. M - Primary
* Dr.- Assisting
No Assistants
Procedure Summary
Anesthesia: General ASA: ASA status not filed in the log.
Estimated Blood Loss: 100mL
Drains: [REMOVED] Urethral Catheter Latex 16 Fr (Removed)
Specimens:
LEFT OVARIAN ECTOPIC PREGNANCY
IUD - GROSS ONLY
Implants:
See Intraoperative Record
Indications: 31 y.o. female who is having a procedure for ruptured ectopic pregnancy.
Procedure Details:
Once the informed consent was reviewed, the patient was taken to the operating room where general anesthesia was given. She was then placed in the dorsal lithotomy position and prepped and draped in the usual sterile fashion. A vaginal sponge stick and a foley catheter were placed. Antibiotic prophylaxis was not indicated.
Pneumoperitoneum was established at the umbilicus with a Veress needle up to 15 mmHg, opening pressure was 5mmHg. A 5 mm incision was then created in the umbilicus and a 5-mm bladeless optical dilating trocar was placed without complications. Under direct vision, with care to locate the inferior epigastric arteries, 5-mm ports were placed in the right lower and mid quadrants and left lower quadrant. All incisions were anesthetized with 0.5% Marcaine without epinephrine prior trochar placement.
The patient was then placed into steep trendelenberg. The pelvis and abdomen were surveyed with the findings noted above.
The left ovarian ectopic pregnancy was identified. Using a Maryland Ligasure device, the ectopic products of conception were sharply dissected from the ovarian stroma. A 5mm endocatch bag was introduced into the abdomen and the ectopic products of conception were placed inside. Further blunt and sharp dissection of the left ovary was performed to remove as much ectopic tissue as possible. The endocatch bag was removed and ectopic products were send for permanent histological specimen.
Attention was turned to the migrated IUD located at the right lateral abdominal wall. The peritoneum overlying the IUD was incised. Using blunt dissection, the IUD was teased out of the capsule and retroperitoneal space with care to avoid surrounding anatomical structures. The IUD was removed intact and placed in a 5mm endocatch bag. The bag was removed and IUD was sent for gross specimen.
Irrigation was performed. The pelvis was inspected. Hemostasis was obtained at the surgical pedicles with gentle monopolar coagulation and application of Arista hemostatic snow.
The instruments were then removed and the gas was allowed to escape fully. The trocars were removed, and the skin incisions were closed with 4-0 Monocryl in a subcuticular fashion and covered with Dermabond.
Final sponge, needle, and instrument counts were correct at the completion of the procedure. The foley catheter and vaginal sponge stick were removed. Patient was then awakened and taken to postanesthesia care unit in stable condition.
Findings:
1. Ruptured bleeding left ovarian ectopic pregnancy, removed mostly intact with remaining small tissue removed separately
2. Large blood and clot in the pelvis upon entry, total 600mL
3. Mirena IUD encapsulated in the retroperitoneum of the right lateral abdominal wall adjacent to the terminal ileum, appendix, and ascending colon; removed intact
3. Hemostatic surgical pedicles at conclusion of procedure
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