coder25
Guru
Dr. performed a subtotal colectomy with placement of VAC-PAC. New surgery for me to code and not sure which one to use.
PT had ischemic bowel. Exploration revealed the patient's left colon to be dead including sigmoid colon and upper rectum as well as the splenic flexure up to about mid to distal transverse, which looked healthier. Cecum was also ischemic appearing and did not appear viable. Subtotal colectomy was decided upon.
Cecum was mobilized and the terminal ileum was taken down with electrocautery. We then took down the white line of Toldt on the right side, completely mobilizing the colon up to the hepatic flexure. A window was then created in the mesentery of the terminal ileum. A GIA100 was used to transect the terminal ileum. The Ligasure impact was then used to take down the entire mesentery of the right colon. Omentum was taken off the transverse colon and the transverse colon was completely mobilized off of stomach and duodenum. Splenic flexure was able to be mobilized w/o injury to the spleen or surrounding structures. Sigmoid colon was taken off its retroperitoneal attachments. Upper aspect of rectum was noted to be necrotic and we had to dissect down to about the mid rectum in order to obtain a more viable distal margin. We then took down part of the mesorectum close to our specimen in an attempt to get as low as possible, again to reach viable bowel. Once this was performed, the area was skeletonized and a window made in the mesentery. EndoGIA stapler was used to transect the rectum. The entire specimen was handed off. Abdomen was irrigated with copiuos amounts of saline. We inspected our rectal staple line and saw that is appeared intact and this tissue was viable. Decision was made to place a trauma VAC PAC in the patient's abdomen and be hooked up to suction for a second look in 24-48 hours, once the patient stabilized.
I found 44150 and 44145. Not sure if this is correct or not due to the VAC being placed. Would I also use 44139?
Thanks for your help!
PT had ischemic bowel. Exploration revealed the patient's left colon to be dead including sigmoid colon and upper rectum as well as the splenic flexure up to about mid to distal transverse, which looked healthier. Cecum was also ischemic appearing and did not appear viable. Subtotal colectomy was decided upon.
Cecum was mobilized and the terminal ileum was taken down with electrocautery. We then took down the white line of Toldt on the right side, completely mobilizing the colon up to the hepatic flexure. A window was then created in the mesentery of the terminal ileum. A GIA100 was used to transect the terminal ileum. The Ligasure impact was then used to take down the entire mesentery of the right colon. Omentum was taken off the transverse colon and the transverse colon was completely mobilized off of stomach and duodenum. Splenic flexure was able to be mobilized w/o injury to the spleen or surrounding structures. Sigmoid colon was taken off its retroperitoneal attachments. Upper aspect of rectum was noted to be necrotic and we had to dissect down to about the mid rectum in order to obtain a more viable distal margin. We then took down part of the mesorectum close to our specimen in an attempt to get as low as possible, again to reach viable bowel. Once this was performed, the area was skeletonized and a window made in the mesentery. EndoGIA stapler was used to transect the rectum. The entire specimen was handed off. Abdomen was irrigated with copiuos amounts of saline. We inspected our rectal staple line and saw that is appeared intact and this tissue was viable. Decision was made to place a trauma VAC PAC in the patient's abdomen and be hooked up to suction for a second look in 24-48 hours, once the patient stabilized.
I found 44150 and 44145. Not sure if this is correct or not due to the VAC being placed. Would I also use 44139?
Thanks for your help!
