KANDREWS131
Networker
I need help coding this procedure. Since he took out part of the small bowel as well, can I just bill a lap enterectomy? I've never dealt with a blind limb before. Thanks!
Initial diagnostic laparoscopy revealed the findings noted above of adhesions from the abdominal wall to the liver consistent with violin string appearance, additional adhesions to the bowel. The gastrojejunal anastomosis was identified and the jejunal Roux limb was run down to the jejunojejunal anastomosis which appeared to be patent. There was no evidence of a Peterson's hernia nor additional mesenteric internal hernia. The adhesions were taken down with a combination of scissors and LigaSure device. After lysing some omental adhesions to expose the gastrojejunal anastomosis a long blind limb was identified. Intraoperatively it measured approximately 20-25 cm. It was also curled up upon itself. This was examined multiple times to ensure this was a blind limb and was verified. After this was verified the blind limb was transected with the GIA stapler and the mesentery taken with the LigaSure device. The resected portion of blind limb/small bowel was placed in endoscopic retrieval bag and removed from the periumbilical port. No additional abnormal findings were noted. At this time the abdomen was reexamined and confirmed to be free of bleeding hemostasis had been achieved. All ports were removed under direct visualization and confirmed to be free of bleeding. The abdomen was allowed to desufflate fully. The Hassan port was removed and this port site was closed with an 0 PDS suture in a figure-of-eight fashion in the fascia. Stay sutures were also utilized in the closure. The skin was then closed with a 4 Monocryl subcuticular suture and Steri-Strips for the skin. Wounds were cleaned and dried and sterile dressings were applied. Patient tolerated the procedure well and sent to the recovery room in stable condition.
Initial diagnostic laparoscopy revealed the findings noted above of adhesions from the abdominal wall to the liver consistent with violin string appearance, additional adhesions to the bowel. The gastrojejunal anastomosis was identified and the jejunal Roux limb was run down to the jejunojejunal anastomosis which appeared to be patent. There was no evidence of a Peterson's hernia nor additional mesenteric internal hernia. The adhesions were taken down with a combination of scissors and LigaSure device. After lysing some omental adhesions to expose the gastrojejunal anastomosis a long blind limb was identified. Intraoperatively it measured approximately 20-25 cm. It was also curled up upon itself. This was examined multiple times to ensure this was a blind limb and was verified. After this was verified the blind limb was transected with the GIA stapler and the mesentery taken with the LigaSure device. The resected portion of blind limb/small bowel was placed in endoscopic retrieval bag and removed from the periumbilical port. No additional abnormal findings were noted. At this time the abdomen was reexamined and confirmed to be free of bleeding hemostasis had been achieved. All ports were removed under direct visualization and confirmed to be free of bleeding. The abdomen was allowed to desufflate fully. The Hassan port was removed and this port site was closed with an 0 PDS suture in a figure-of-eight fashion in the fascia. Stay sutures were also utilized in the closure. The skin was then closed with a 4 Monocryl subcuticular suture and Steri-Strips for the skin. Wounds were cleaned and dried and sterile dressings were applied. Patient tolerated the procedure well and sent to the recovery room in stable condition.