toria11
Guru
Hi! I would like your opinion on whether modifier 22 is warranted here. The provider states in his OP note that a counter incision was necessary to remove the reservoir and that it took about an hour to remove that one component. Thanks!
POSTOPERATIVE DIAGNOSIS: Eroded artificial urinary sphincter.
PROCEDURE PERFORMED: Complete removal of all components of an AMS
artificial urinary sphincter.
ANESTHESIA: General.
DETAILS OF PROCEDURE:
He has done very well with the sphincter over the course of the spring and in the summer. However, in preparation for move to Connecticut, he has been
doing some very heavy lifting, etc. He heard a pop, felt some suprapubic discomfort, etc., which led to a
cystoscopy, which unfortunately showed that the cuff had eroded at around the 12 or 1 o'clock position on
into the urethra. We know from experience that the best way to handle the situation is to completely
remove all of the existing components, allow the urethra to heal and then perhaps come back and try again
a few months down the line. So, he has disappointed and so are we.
He was taken to the operating room, given a general anesthetic, a timeout was taken for identification purposes. He then prepped and draped in a sterile
fashion, and a perineal incision was made taken down to the existing cuff, which was removed in its
entirety and the urethral pseudoepithelialized capsule around the cuff was then whipstitched watertight in
the hopes at that will help the urethra heal over more quickly. A 16 French Foley catheter was inserted on
into the urethra into the bladder without any difficulty. The previous incision in the right hemiscrotum was
then cut down upon the release and to remove the pump. Unfortunately, a counter incision was necessary
in the right lower quadrant over his inguinal canal in order to get down to the reservoir, which was very
difficult to remove. I probably spent to an hour trying to do it at least. Finally, we were able to get it out in
its entirety. There was no bleeding identified. The inguinal incision and that wound was closed in a
multitude of interrupted layers. The skin was closed over subcuticularly. The right penis scrotal junction
incision was closed in a similar fashion as was the perineum. These wounds were all appropriately bandaged. He tolerated the procedure well. He was returned to the
recovery room in stable condition
POSTOPERATIVE DIAGNOSIS: Eroded artificial urinary sphincter.
PROCEDURE PERFORMED: Complete removal of all components of an AMS
artificial urinary sphincter.
ANESTHESIA: General.
DETAILS OF PROCEDURE:
He has done very well with the sphincter over the course of the spring and in the summer. However, in preparation for move to Connecticut, he has been
doing some very heavy lifting, etc. He heard a pop, felt some suprapubic discomfort, etc., which led to a
cystoscopy, which unfortunately showed that the cuff had eroded at around the 12 or 1 o'clock position on
into the urethra. We know from experience that the best way to handle the situation is to completely
remove all of the existing components, allow the urethra to heal and then perhaps come back and try again
a few months down the line. So, he has disappointed and so are we.
He was taken to the operating room, given a general anesthetic, a timeout was taken for identification purposes. He then prepped and draped in a sterile
fashion, and a perineal incision was made taken down to the existing cuff, which was removed in its
entirety and the urethral pseudoepithelialized capsule around the cuff was then whipstitched watertight in
the hopes at that will help the urethra heal over more quickly. A 16 French Foley catheter was inserted on
into the urethra into the bladder without any difficulty. The previous incision in the right hemiscrotum was
then cut down upon the release and to remove the pump. Unfortunately, a counter incision was necessary
in the right lower quadrant over his inguinal canal in order to get down to the reservoir, which was very
difficult to remove. I probably spent to an hour trying to do it at least. Finally, we were able to get it out in
its entirety. There was no bleeding identified. The inguinal incision and that wound was closed in a
multitude of interrupted layers. The skin was closed over subcuticularly. The right penis scrotal junction
incision was closed in a similar fashion as was the perineum. These wounds were all appropriately bandaged. He tolerated the procedure well. He was returned to the
recovery room in stable condition