mfournier
Networker
Hello Everyone:
Was wondering if someone can assist with this question. OB-Gyn called one of my general surgeons to assist on a case. OB-Gyn billed for 49900 and we billed 44602. The 44602 was denied. Just wondering if there is another code we can bill or should we just be the assistant to the 49900.
Procedure: Laparotomy, abdominal washout, evaluation of small intestine with sutured enterorrhaphy, assistance to Dr. McVay with abdominal wall closure.
Findings: Viable segment of small intestine involved in the evisceration with 1 small 2 mm area of punctate subserosal ecchymosis oversewn with 3-0 Vicryl Lembert enterorrhaphy.
Complications: None
Indication for procedure: Patient is a 25-year-old female now postop day 6 from C-section. She returned to the hospital today with acutely worsening abdominal pain, and a bulge in the wound. Evaluation emergency department was concerning for evisceration with visible small intestine. General surgical consultation was requested. Please see this note for full detail. Patient was consented by Dr. XXX for laparotomy abdominal washout and abdominal wall closure. I discussed my role in the patient's care in the preoperative holding area for evaluation of small intestine and consideration for possible resection if indicated.
Operative technique: After induction general endotracheal anesthesia, surgical timeout was conducted with institutional protocol. The abdomen sterilely prepped and draped standard sterile surgical fashion. I assisted Dr. XXx in opening the abdominal wound for superficial the skin level, then the abdominal wall. The small intestine was somewhat hyperemic, but appeared viable. Once fascia was opened, the small intestine was immediately reduced into the abdominal cavity to improve perfusion and allow for later further evaluation. We now turned our attention to full assessment of the fascia. To assist with closure, we dissected back on the subcutaneous fatty tissue circumferentially around the fascia exposing 1 to 2 cm of fascia all the way about the incision for later closure. Once this was accomplished, we turned our attention to abdominal cavity, and the intestine was delivered into the field. The area of evisceration was easily able to be identified by the hyperemia of the area with areas of superficial ecchymosis along the mesenteric margin at the point where the small intestine exited the fascia, but at this point the bowel appeared entirely viable and well perfused. One small 2 mm area of superficial subserosal ecchymosis was noted, and elected to imbricate this area with 3 interrupted 3-0 Vicryl Lembert sutures. At this time the remaining small bowel was normal in appearance, and again appeared well perfused. The mesentery supplying the area was stable at this time, and no evidence for expanding hematoma or other concern was identified. This 1 test was again reduced to abdominal cavity. The abdomen is now copiously irrigated and the irrigant was recovered. He quickly ran clear. We now turned our attention to closure, and I assisted Dr. XXX in doing so. The peritoneum along the posterior aspect of the rectus muscle was reapproximated using a 0 Vicryl suture 1 begun superiorly, 1 begun inferiorly and secured to itself in the midportion of the rectus belly. This is done to exclude the small intestine from coming through the rectus belly and under the fascial repair. We now turned attention to fascial repair. This was done in an interrupted manner with PDS suture. Please see Dr. XXX note for full detail. Skin closed with surgical staples. Dry sterile dressing applied. I was present for the entire case as detailed, assisting Dr. XXX with abdominal wall closure, with the enterorrhaphy and assessment of the small intestine performed by me. All sponge instrument sharp counts reported correct by the operating room staff. After anesthesia was reversed, the patient was extubated, patient taken to postanesthesia care in stable condition having tolerated the procedure well no apparent immediate complication.
Thank you for any advice,
MF
Was wondering if someone can assist with this question. OB-Gyn called one of my general surgeons to assist on a case. OB-Gyn billed for 49900 and we billed 44602. The 44602 was denied. Just wondering if there is another code we can bill or should we just be the assistant to the 49900.
Procedure: Laparotomy, abdominal washout, evaluation of small intestine with sutured enterorrhaphy, assistance to Dr. McVay with abdominal wall closure.
Findings: Viable segment of small intestine involved in the evisceration with 1 small 2 mm area of punctate subserosal ecchymosis oversewn with 3-0 Vicryl Lembert enterorrhaphy.
Complications: None
Indication for procedure: Patient is a 25-year-old female now postop day 6 from C-section. She returned to the hospital today with acutely worsening abdominal pain, and a bulge in the wound. Evaluation emergency department was concerning for evisceration with visible small intestine. General surgical consultation was requested. Please see this note for full detail. Patient was consented by Dr. XXX for laparotomy abdominal washout and abdominal wall closure. I discussed my role in the patient's care in the preoperative holding area for evaluation of small intestine and consideration for possible resection if indicated.
Operative technique: After induction general endotracheal anesthesia, surgical timeout was conducted with institutional protocol. The abdomen sterilely prepped and draped standard sterile surgical fashion. I assisted Dr. XXx in opening the abdominal wound for superficial the skin level, then the abdominal wall. The small intestine was somewhat hyperemic, but appeared viable. Once fascia was opened, the small intestine was immediately reduced into the abdominal cavity to improve perfusion and allow for later further evaluation. We now turned our attention to full assessment of the fascia. To assist with closure, we dissected back on the subcutaneous fatty tissue circumferentially around the fascia exposing 1 to 2 cm of fascia all the way about the incision for later closure. Once this was accomplished, we turned our attention to abdominal cavity, and the intestine was delivered into the field. The area of evisceration was easily able to be identified by the hyperemia of the area with areas of superficial ecchymosis along the mesenteric margin at the point where the small intestine exited the fascia, but at this point the bowel appeared entirely viable and well perfused. One small 2 mm area of superficial subserosal ecchymosis was noted, and elected to imbricate this area with 3 interrupted 3-0 Vicryl Lembert sutures. At this time the remaining small bowel was normal in appearance, and again appeared well perfused. The mesentery supplying the area was stable at this time, and no evidence for expanding hematoma or other concern was identified. This 1 test was again reduced to abdominal cavity. The abdomen is now copiously irrigated and the irrigant was recovered. He quickly ran clear. We now turned our attention to closure, and I assisted Dr. XXX in doing so. The peritoneum along the posterior aspect of the rectus muscle was reapproximated using a 0 Vicryl suture 1 begun superiorly, 1 begun inferiorly and secured to itself in the midportion of the rectus belly. This is done to exclude the small intestine from coming through the rectus belly and under the fascial repair. We now turned attention to fascial repair. This was done in an interrupted manner with PDS suture. Please see Dr. XXX note for full detail. Skin closed with surgical staples. Dry sterile dressing applied. I was present for the entire case as detailed, assisting Dr. XXX with abdominal wall closure, with the enterorrhaphy and assessment of the small intestine performed by me. All sponge instrument sharp counts reported correct by the operating room staff. After anesthesia was reversed, the patient was extubated, patient taken to postanesthesia care in stable condition having tolerated the procedure well no apparent immediate complication.
Thank you for any advice,
MF
