I have received 3 different variations of coding on a single note in regards to drainage of abscess. All from supposed certified coders. Now I have confused myself. Can I get opinions on what should be billed with the 47562?
OPERATIVE FINDINGS:
Acutely inflamed enlarged gallbladder with the right upper quadrant abscess.
OPERATIVE SUMMARY:
The patient was brought to the operating room and placed in the supine position. Following excellent general endotracheal anesthetic, sequential compression devices were placed on the calves bilaterally. A Foley catheter was placed to gravity. Timeout was accomplished. He was already on around-the-clock antibiotics. Following prepping and draping of his abdomen, an incision was made sharply at the umbilicus and carried down bluntly through the subcutaneous tissue. Linea alba was identified and transected sharply. Blunt dissection was used to enter the peritoneal cavity uneventfully. Pus was immediately noted. Heavy Vicryl sutures were placed on either edge of the fascia. The Hassan cannula was carefully inserted, and CO2 pneumoperitoneum
was achieved. The camera was carefully inserted, and under direct visualization, 5-millimeters trocars were introduced in the subxiphoid and right upper quadrant positions uneventfully. The patient was positioned in reverse Trendelenburg and left laterally. The gallbladder was acutely inflamed and distended. Photograph of the right upper quadrant purulent rind covering the liver was taken. The gallbladder was drained using a needle trocar catheter under direct visualization. The gallbladder was then retracted cephalad.
Using the J-hook and cautery, the cystic duct and hepatocystic triangle were carefully defined. Care was taken to stay well away from the territory of the common bile duct.Following definition of the cystic duct, three clips were placed on the patient's side, two on the specimen side, and was transected sharply, and the cystic duct was then transected sharply between those clips. The cystic artery was likewise dissected out and clipped several times on the patient's side and once on the specimen side and transected sharply between those clips. An additional possible accessory duct was likewise clipped as
it went directly to the gallbladder. The gallbladder was then taken down off the liver bed using the hook and cautery. The gallbladder was very friable and edematous and inflamed. Prior to completely removing the gallbladder, the liver bed was inspected. The cystic duct stump and cystic artery stump were carefully inspected. No bile leak was seen. Hemostasis was noted. The gallbladder was then completely removed off the liver bed. The camera was
switched to the subxiphoid position. An Endopouch was introduced through the umbilical cannula under direct visualization. The gallbladder was carefully placed in the Endopouch and brought through the umbilical position under direct visualization uneventfully. The camera was then switched back to the umbilicus. Right upper quadrant was irrigated liberally. No bleeding was noted. The remaining abscess and purulent material was aspirated out and irrigated thoroughly. A Jackson-Pratt drain was laid in place in the
gallbladder fossa. It was brought through one of the right upper quadrant cannulas and secured to the skin using Ethibond suture. It was connected to bulb suction. The CO2 pneumoperitoneum was released, and the instruments were removed. The fascia at the umbilicus was closed with heavy Vicryl sutures in simple interrupted fashion. Skin incisions were closed with fine subcuticular absorbable sutures. Wounds were injected with Marcaine and dressed in sterile fashion.
OPERATIVE FINDINGS:
Acutely inflamed enlarged gallbladder with the right upper quadrant abscess.
OPERATIVE SUMMARY:
The patient was brought to the operating room and placed in the supine position. Following excellent general endotracheal anesthetic, sequential compression devices were placed on the calves bilaterally. A Foley catheter was placed to gravity. Timeout was accomplished. He was already on around-the-clock antibiotics. Following prepping and draping of his abdomen, an incision was made sharply at the umbilicus and carried down bluntly through the subcutaneous tissue. Linea alba was identified and transected sharply. Blunt dissection was used to enter the peritoneal cavity uneventfully. Pus was immediately noted. Heavy Vicryl sutures were placed on either edge of the fascia. The Hassan cannula was carefully inserted, and CO2 pneumoperitoneum
was achieved. The camera was carefully inserted, and under direct visualization, 5-millimeters trocars were introduced in the subxiphoid and right upper quadrant positions uneventfully. The patient was positioned in reverse Trendelenburg and left laterally. The gallbladder was acutely inflamed and distended. Photograph of the right upper quadrant purulent rind covering the liver was taken. The gallbladder was drained using a needle trocar catheter under direct visualization. The gallbladder was then retracted cephalad.
Using the J-hook and cautery, the cystic duct and hepatocystic triangle were carefully defined. Care was taken to stay well away from the territory of the common bile duct.Following definition of the cystic duct, three clips were placed on the patient's side, two on the specimen side, and was transected sharply, and the cystic duct was then transected sharply between those clips. The cystic artery was likewise dissected out and clipped several times on the patient's side and once on the specimen side and transected sharply between those clips. An additional possible accessory duct was likewise clipped as
it went directly to the gallbladder. The gallbladder was then taken down off the liver bed using the hook and cautery. The gallbladder was very friable and edematous and inflamed. Prior to completely removing the gallbladder, the liver bed was inspected. The cystic duct stump and cystic artery stump were carefully inspected. No bile leak was seen. Hemostasis was noted. The gallbladder was then completely removed off the liver bed. The camera was
switched to the subxiphoid position. An Endopouch was introduced through the umbilical cannula under direct visualization. The gallbladder was carefully placed in the Endopouch and brought through the umbilical position under direct visualization uneventfully. The camera was then switched back to the umbilicus. Right upper quadrant was irrigated liberally. No bleeding was noted. The remaining abscess and purulent material was aspirated out and irrigated thoroughly. A Jackson-Pratt drain was laid in place in the
gallbladder fossa. It was brought through one of the right upper quadrant cannulas and secured to the skin using Ethibond suture. It was connected to bulb suction. The CO2 pneumoperitoneum was released, and the instruments were removed. The fascia at the umbilicus was closed with heavy Vicryl sutures in simple interrupted fashion. Skin incisions were closed with fine subcuticular absorbable sutures. Wounds were injected with Marcaine and dressed in sterile fashion.
