MeriAnn
New
Any help with coding the following would be greatly appreciated. We were thinking that 49329 was the correct code but was not sure what to benchmark it to.
preoperative diagnosis: Postoperative intraperitoneal bleed after prostatectomy
Postoperative diagnosis: Same as preoperative
Procedure performed: Laparoscopy with evacuation of intraperitoneal clot (700 mL)
Ligation of bleeding incisional blood vessel and reclosure of midline extraction site.
He was brought to the operating suite and given a general anesthesia and IV Ancef. He was prepped and draped in sterile fashion in a supine position.
His Foley catheter was left in place and his urine was a light pink in color. I then removed the Dermabond and cut the sutures at his port sites in the right uppermost assistant port as well as the right mid port and left mid port. 12 mm ports were placed in each of these and the 10 mm camera with 0Deg lens was used to visualize the peritoneum. A total of 700 mL of clot was evacuated throughout the procedure.
On visualization of the anastomosis there was some old small clot adherent to this but it did not look to be the source of the bleeding. There was some old blood in the right lower pelvis more so than the left lower pelvis. On inspection of the abdominal wall there was a consistent steady dripping of blood from the midline incision port site. It was not heavy but rather a dripping but it was constant. This was thought to be the source of the bleeding.
We then opened the umbilical incision site and oversewed the fascia muscle and peritoneal lining with a #1 looped PDS suture and took wider bites on the fascia and tissue. After completely closing it we then looked back through the ports and there was no further bleeding from the site either from the abdominal side externally or the internal side. The rest of the port sites were visualized as each port site was extracted and there was no bleeding from night these either. The blood appeared to have stopped.
He was kept in Trendelenburg position throughout the procedure in order to help move the bowel away from the pelvis. I did put some Surgifoam and Surgical down in the pelvis. there is no further blood welling up and the surgical sites were all closed using 4-0 Monocryl subcuticular suture and Dermabond was placed on the skin. I did leave a #10 flat Jackson-Pratt drain coming out the left lower quadrant and sutured the skin with a 2-0 silk.
preoperative diagnosis: Postoperative intraperitoneal bleed after prostatectomy
Postoperative diagnosis: Same as preoperative
Procedure performed: Laparoscopy with evacuation of intraperitoneal clot (700 mL)
Ligation of bleeding incisional blood vessel and reclosure of midline extraction site.
He was brought to the operating suite and given a general anesthesia and IV Ancef. He was prepped and draped in sterile fashion in a supine position.
His Foley catheter was left in place and his urine was a light pink in color. I then removed the Dermabond and cut the sutures at his port sites in the right uppermost assistant port as well as the right mid port and left mid port. 12 mm ports were placed in each of these and the 10 mm camera with 0Deg lens was used to visualize the peritoneum. A total of 700 mL of clot was evacuated throughout the procedure.
On visualization of the anastomosis there was some old small clot adherent to this but it did not look to be the source of the bleeding. There was some old blood in the right lower pelvis more so than the left lower pelvis. On inspection of the abdominal wall there was a consistent steady dripping of blood from the midline incision port site. It was not heavy but rather a dripping but it was constant. This was thought to be the source of the bleeding.
We then opened the umbilical incision site and oversewed the fascia muscle and peritoneal lining with a #1 looped PDS suture and took wider bites on the fascia and tissue. After completely closing it we then looked back through the ports and there was no further bleeding from the site either from the abdominal side externally or the internal side. The rest of the port sites were visualized as each port site was extracted and there was no bleeding from night these either. The blood appeared to have stopped.
He was kept in Trendelenburg position throughout the procedure in order to help move the bowel away from the pelvis. I did put some Surgifoam and Surgical down in the pelvis. there is no further blood welling up and the surgical sites were all closed using 4-0 Monocryl subcuticular suture and Dermabond was placed on the skin. I did leave a #10 flat Jackson-Pratt drain coming out the left lower quadrant and sutured the skin with a 2-0 silk.
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