cubbiecatz
Networker
Hello. I already know the vaginal cuff repair is an unlisted code and I think the laparoscopic partial omentectomy would be unlisted as well but I'm hoping someone can give me better guidance or which CPT code to compare for reimbursement of the procedures.
The patient had a hysterectomy on 1/15/25. This procedure took place 3/7/25.
Thank you!
PREOPERATIVE DIAGNOSES:
Vaginal cuff dehiscence
Prolapsed omentum through vaginal cuff
POSTOPERATIVE DIAGNOSES:
Vaginal cuff dehiscence
Prolapsed omentum through vaginal cuff
PROCEDURE/S:
Procedure(s):
Laparoscopy with partial omentectomy and vaginal cuff repair
ANESTHESIA: General
ESTIMATED BLOOD LOSS: <5 ml
COMPLICATIONS: None
FINDINGS:
1. The omentum was noted to be prolapsed through the vaginal cuff dehiscence visualizing it from above using the laparoscope and below.
2. Hemostasis acquired
POSTOPERATIVE CONDITION: Stable
SPONGE, NEEDLE, INSTRUMENT COUNT: Reported correct times three.
SPECIMENS: Omentum
DRAINS: None
DVT PROPHYLASIS: Sequential compression devices applied to both legs.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room where she was identified. She was laid in the supine position and given general endotracheal anesthesia. Legs were then placed in the Allen stirrups and she was prepped and draped in the usual sterile manner. A timeout was performed indicating the above-named procedure.
A posterior weighted speculum was placed in the vagina and there was noted what appeared to be omentum protruding through the vaginal cuff which had dehisced after intercourse. There was still question as to whether or not this could be bowel protruding through the vaginal cuff. The laparoscopy was then performed. The supraumbilical fold incision was injected with lidocaine and then opened. A 5 mm bladeless trocar was then placed under direct visualization using the Optiview. After ensuring intraperitoneal placement the CO2 gas was turned on and the abdomen insufflated to 15 mmHg. One 5 mm bladeless trocar was placed lateral to the supraumbilical port where the previous port site for her robotic hysterectomy was placed. This was done under direct visualization. A 5 mm bladeless trocar was then placed in the right lower quadrant under direct visualization. The above findings were noted. The omentum was noted to be protruding through the vaginal cuff. Dr. assistant used ring forceps from below to help bluntly dissect the omentum from the vaginal cuff. The omentum was then completely brought into the abdominal cavity and the necrosis end of the omentum was excised from the omentum drape using the Enseal device. Once it was completely divided from the remainder of the omentum, the specimen was placed through the vaginal cuff and pulled out with ring forceps by Dr. Assistant. This completed the laparoscopic portion of the procedure. The CO2 gas was allowed escape from the abdomen, the trocars removed and stainless steel skin clips placed. The vaginal cuff was closed by using 2 figure-of-eight sutures, 1 on the right apex and 1 on the left apex suturing in a running fashion to the midline and then these 2 were tied together. Perfect hemostasis was noted. This completed the procedure. The patient was then cleaned off, extubated and transported to the recovery room in stable condition.
Pathololgy:
Final Diagnosis --
Omentum, excision:
– Benign fibroadipose tissue with focal acute and chronic inflammation and reactive changes.
– Negative for malignancy.
Thank you, Cathy
The patient had a hysterectomy on 1/15/25. This procedure took place 3/7/25.
Thank you!
PREOPERATIVE DIAGNOSES:
Vaginal cuff dehiscence
Prolapsed omentum through vaginal cuff
POSTOPERATIVE DIAGNOSES:
Vaginal cuff dehiscence
Prolapsed omentum through vaginal cuff
PROCEDURE/S:
Procedure(s):
Laparoscopy with partial omentectomy and vaginal cuff repair
ANESTHESIA: General
ESTIMATED BLOOD LOSS: <5 ml
COMPLICATIONS: None
FINDINGS:
1. The omentum was noted to be prolapsed through the vaginal cuff dehiscence visualizing it from above using the laparoscope and below.
2. Hemostasis acquired
POSTOPERATIVE CONDITION: Stable
SPONGE, NEEDLE, INSTRUMENT COUNT: Reported correct times three.
SPECIMENS: Omentum
DRAINS: None
DVT PROPHYLASIS: Sequential compression devices applied to both legs.
DESCRIPTION OF PROCEDURE:
The patient was taken to the operating room where she was identified. She was laid in the supine position and given general endotracheal anesthesia. Legs were then placed in the Allen stirrups and she was prepped and draped in the usual sterile manner. A timeout was performed indicating the above-named procedure.
A posterior weighted speculum was placed in the vagina and there was noted what appeared to be omentum protruding through the vaginal cuff which had dehisced after intercourse. There was still question as to whether or not this could be bowel protruding through the vaginal cuff. The laparoscopy was then performed. The supraumbilical fold incision was injected with lidocaine and then opened. A 5 mm bladeless trocar was then placed under direct visualization using the Optiview. After ensuring intraperitoneal placement the CO2 gas was turned on and the abdomen insufflated to 15 mmHg. One 5 mm bladeless trocar was placed lateral to the supraumbilical port where the previous port site for her robotic hysterectomy was placed. This was done under direct visualization. A 5 mm bladeless trocar was then placed in the right lower quadrant under direct visualization. The above findings were noted. The omentum was noted to be protruding through the vaginal cuff. Dr. assistant used ring forceps from below to help bluntly dissect the omentum from the vaginal cuff. The omentum was then completely brought into the abdominal cavity and the necrosis end of the omentum was excised from the omentum drape using the Enseal device. Once it was completely divided from the remainder of the omentum, the specimen was placed through the vaginal cuff and pulled out with ring forceps by Dr. Assistant. This completed the laparoscopic portion of the procedure. The CO2 gas was allowed escape from the abdomen, the trocars removed and stainless steel skin clips placed. The vaginal cuff was closed by using 2 figure-of-eight sutures, 1 on the right apex and 1 on the left apex suturing in a running fashion to the midline and then these 2 were tied together. Perfect hemostasis was noted. This completed the procedure. The patient was then cleaned off, extubated and transported to the recovery room in stable condition.
Pathololgy:
Final Diagnosis --
Omentum, excision:
– Benign fibroadipose tissue with focal acute and chronic inflammation and reactive changes.
– Negative for malignancy.
Thank you, Cathy
