coder25
Guru
I am not sure if I can code the right hemicolectomy. See OP note below.
PROCEDURES: Ex. lap, extended right hemicolectomy with ileostomy/mucuous fistula, gastrojejunostomy, EGD, partial omentectomy.
DESCRIPTION: Abdomen was prepped and draped in usual fashion. Midline incision was created. Electrocautery was used to dissect through the subq tissues into abd. cavity, which contained over 1500 ml of ascites. This was suctione and it was clear in examining the abd, there was carcinomatosis with miliary disease along the pelvic periotoneal surfaces extending into the left paracolic gutter and some more bulky disease at the lumbar shelf region which was partially obstructing the sigmoid colon. No gross evidence of liver disease was noted. There was some disesae along the SB mesentery with a bulky lesion at the ileocecal valve in addition to along the right paracolic gutter. There was some omental disease as well. Part of the omentum was removed and sent for frozen section, which demonstrated adenocarcinoma.
Upper endoscopy demonstrated a mass in the duodenum, which was near obstructing. The stomach contained 800 mL of fluid, despite being NPO liquids for several days.
For palliation, I felt he would have imminent SBO secondary to the ileocecal mass, in addition, to several lesions along the right colon. The transverse and descending colon were essentially free of disease until the sigmoid obstruction. I was ale to mobilize the right colon and termminal ileum and hepatic flexure in order to perform an extended right hemicolectomy as a palliative procedure. The terminal ileum was divided with GIA as was the distal transverse colon. The mesentery of the SB and right colon was divided with a ligature. THe middle colic was suture ligated with 0 vicryl sutures and specimen removed from field. This allowed creation of an ileostomy and mucous fistula, later in the case.
In order to bypass near obstructing duodenal lesion, I identified the ligament of Treitz appx. 20 cm distal to this. The SB was brought up throught space created by the extended right hemicolectomy into the lesser sac. THe posterior wall of the stomach was able to be mobilaized enough to create a posterior stapled gastrojejunostomy with a GIA. The enterotomy was closed with GIA as well.
A circular incision was then made into the RLQ and LUQ. Ileum was delivered in the RLQ and sutured to the abdominal wall with 2-0 VIcryl. The distal transverse colon was mobilized to the LUQ as a mucous fistula.
Since he stated the extended hemicolectomy was palliative, can it be billed?
Thanks in advance for your help!
PROCEDURES: Ex. lap, extended right hemicolectomy with ileostomy/mucuous fistula, gastrojejunostomy, EGD, partial omentectomy.
DESCRIPTION: Abdomen was prepped and draped in usual fashion. Midline incision was created. Electrocautery was used to dissect through the subq tissues into abd. cavity, which contained over 1500 ml of ascites. This was suctione and it was clear in examining the abd, there was carcinomatosis with miliary disease along the pelvic periotoneal surfaces extending into the left paracolic gutter and some more bulky disease at the lumbar shelf region which was partially obstructing the sigmoid colon. No gross evidence of liver disease was noted. There was some disesae along the SB mesentery with a bulky lesion at the ileocecal valve in addition to along the right paracolic gutter. There was some omental disease as well. Part of the omentum was removed and sent for frozen section, which demonstrated adenocarcinoma.
Upper endoscopy demonstrated a mass in the duodenum, which was near obstructing. The stomach contained 800 mL of fluid, despite being NPO liquids for several days.
For palliation, I felt he would have imminent SBO secondary to the ileocecal mass, in addition, to several lesions along the right colon. The transverse and descending colon were essentially free of disease until the sigmoid obstruction. I was ale to mobilize the right colon and termminal ileum and hepatic flexure in order to perform an extended right hemicolectomy as a palliative procedure. The terminal ileum was divided with GIA as was the distal transverse colon. The mesentery of the SB and right colon was divided with a ligature. THe middle colic was suture ligated with 0 vicryl sutures and specimen removed from field. This allowed creation of an ileostomy and mucous fistula, later in the case.
In order to bypass near obstructing duodenal lesion, I identified the ligament of Treitz appx. 20 cm distal to this. The SB was brought up throught space created by the extended right hemicolectomy into the lesser sac. THe posterior wall of the stomach was able to be mobilaized enough to create a posterior stapled gastrojejunostomy with a GIA. The enterotomy was closed with GIA as well.
A circular incision was then made into the RLQ and LUQ. Ileum was delivered in the RLQ and sutured to the abdominal wall with 2-0 VIcryl. The distal transverse colon was mobilized to the LUQ as a mucous fistula.
Since he stated the extended hemicolectomy was palliative, can it be billed?
Thanks in advance for your help!