Clueless....I can code each seperate but not sure if there are codes that capture a combo of the services. Can anyone share what they would code? Thanks!
1.LEFT INGUINAL HERNIA
2.EXPLORATORY LAP
3.SIGMOID COLECTOMYW/PRIMARY ANASTOMOSIS
Pt had large mass in his left scrotum that was firm and irreducible, anatomic ladmarks of the pubic tubercle and anterior superior iliac spine were indentified. A transverse incision was then made in skin crease and carried down throught the scbcu fat and fascia to revieal the fibers of the external oblique. Oblique then incised and spermatic cord identified. Cord was large and indurated. Significant amount of inflamation. Hernia appeared firm and fixed. Significant effort involved in trying to reduce it from this approach. Given pre-op CT noted colonic involvement, sac was incised and noted bloody fluid returned. Decision made to perform midline laparotomy to safely eval the colon. A lower midline incision made and through subcutaneous tissue to fascia. Fascia incised and abdomen entered. Same bloody fluid noted throughout abdomen. No clots and fluid did not appear to be from new bleeding. Small bowel examined, noted dilated and colon traced to left side where it did not appear obstructed but indurated and herniated through a large defect within the inguinal canal. Using reduction, external pressure and manipulation of the bowel, colon slowly reduced. Once mass reduced colon examined. Sigmoid colon thinkened cyst-like structure that was adherent to the bowel. The bowel did not appear to be grossly perforated nor did it seem to be the margin of the bloody fluid. There were multiple serosal tears from the reduction process and given the redundancy of entry the bowel decision was made to resect it. Prior to dissection, attention turned back to hernia where spermatic cord was mobilized. The thickened peritoneal sac dissected from cord and passed off. A large plug placed in defect of canal. An overlying patch was placed and anchored medially to the pubic tubercle, inferiorly to the inguinal ligament and superiorly to the transversalis fascia. Mest inserted and oblique closed.
Returned back to abdomen, colon noted to be in bad shape and need of resection. The Proximal and distal resection points indentified and linear cutting stapler was then used to transect the colon and mesentery was then divided. The peritoneal sac still attached to both colon and colonic segment was passed off. ends of colon anastomosed using stapler. The colotomy repaired in two layers. Mesenteric defect closed. Retroperitoneal defect closed. Abdomen irrigated and closed
Thanks everyone !!!!
1.LEFT INGUINAL HERNIA
2.EXPLORATORY LAP
3.SIGMOID COLECTOMYW/PRIMARY ANASTOMOSIS
Pt had large mass in his left scrotum that was firm and irreducible, anatomic ladmarks of the pubic tubercle and anterior superior iliac spine were indentified. A transverse incision was then made in skin crease and carried down throught the scbcu fat and fascia to revieal the fibers of the external oblique. Oblique then incised and spermatic cord identified. Cord was large and indurated. Significant amount of inflamation. Hernia appeared firm and fixed. Significant effort involved in trying to reduce it from this approach. Given pre-op CT noted colonic involvement, sac was incised and noted bloody fluid returned. Decision made to perform midline laparotomy to safely eval the colon. A lower midline incision made and through subcutaneous tissue to fascia. Fascia incised and abdomen entered. Same bloody fluid noted throughout abdomen. No clots and fluid did not appear to be from new bleeding. Small bowel examined, noted dilated and colon traced to left side where it did not appear obstructed but indurated and herniated through a large defect within the inguinal canal. Using reduction, external pressure and manipulation of the bowel, colon slowly reduced. Once mass reduced colon examined. Sigmoid colon thinkened cyst-like structure that was adherent to the bowel. The bowel did not appear to be grossly perforated nor did it seem to be the margin of the bloody fluid. There were multiple serosal tears from the reduction process and given the redundancy of entry the bowel decision was made to resect it. Prior to dissection, attention turned back to hernia where spermatic cord was mobilized. The thickened peritoneal sac dissected from cord and passed off. A large plug placed in defect of canal. An overlying patch was placed and anchored medially to the pubic tubercle, inferiorly to the inguinal ligament and superiorly to the transversalis fascia. Mest inserted and oblique closed.
Returned back to abdomen, colon noted to be in bad shape and need of resection. The Proximal and distal resection points indentified and linear cutting stapler was then used to transect the colon and mesentery was then divided. The peritoneal sac still attached to both colon and colonic segment was passed off. ends of colon anastomosed using stapler. The colotomy repaired in two layers. Mesenteric defect closed. Retroperitoneal defect closed. Abdomen irrigated and closed
Thanks everyone !!!!