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Need help with complicated multiple surgeries

Hi, Can anyone help me with some CPT codes for a patient who had multiple surgeries? On 9/13, she had a sigmoid colon resection with end to end anastomosis. For that I am using 44147. She developed peritonitis, and on 9/18, she had a re-opening of the laparotomy, irrigation and drainage, repair of an anastomotic leak, and a diverting loop ileostomy. The wound was closed with loose surgical cliips. For the ileostomy, I am using 44310; don’t know if I can charge for the repair of the anastomosis or what code I would use for it (44799?). She developed leukocytosis, and on 9/21, had a second look laparotomy and washout. Fluid collections were aspirated, abdominal cavity was irrigated. The wound was not closed, but a wound vac was applied. I was thinking 49002 for the re-opening of the laparotomy, and 97605 for the wound vac, but don’t know if there’s anything else I can charge. On 9/23, she went back for a limited abdominal exploration (separated multiple loops of small bowel), suctioned out some fluid, and applied wound vac. Don’t know if I can charge 49002, as the wound was left open last time. On 9/25, she went back to OR and was found to have a rupture of a suture line at the anastomosis. She had irrigation and drainage, closure of the rectal stump, closure of proximal descending colon, lysis of adhesions, wound vac. Doctor commented that the small bowel, mesentery, omentum and abdominal wall remained edematous and non-compliant. Again, I don’t know if I can charge for the closure of the rectal stump ( that was to repair the rupture of the anastomosis), or what code I would use for it. They were going to do a loop colostomy, but the descending colon did not have enough mobility to reach the skin level, so they closed it off (oversewn to a blind end) and will re-evaluate it in 48 hours. Don’t know what code to use for that. I’m guessing some of these will be unlisted. On 9/27, she had mobilization of the splenic flexure, end descending colostomy (opening was lateral and cephalad to the umbilicus), irrigation and drainage, and wound vac. Not sure if I should use 44141, 44143, or something else, as at this visit, they didn’t remove any parts of the colon.
Any help on this mess would be appreciated, as it is just beyond my experience.
Thank you!
Donna H.

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