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Diagnostic Laparoscopy, Removal of Anti-reflux Device

Posted on May 31, 2018 by CPC Exam Medical Coding Updates

Can someone please help me with this one. There is no specific code. I choose 49329 but wanted to know if are any other codes.

Diagnostic laparoscopy, explant of Angelchik device.

Operative Technique:
After obtaining informed consent, the patient was taken to the operating room and placed in the supine position. Following the smooth induction of general endotracheal anesthesia and a surgical time-out, the abdomen was prepped and draped in a standard and sterile manner. Hasson technique was utilized to enter the peritoneal cavity supraumbilically, and pneumoperitoneum was established to 15 mmHg. A 10mm, 30-degree laparoscope was introduced and intraabdominal adhesions were present throughout.

Fortunately, the left upper quadrant was relatively free of adhesions, and two 5 mm ports were placed in the left lateral abdomen under direct vision. Inspection in the epigastrium revealed a Silastic or silicone-appearing ring free-floating in the left upper quadrant. The right structure was consistent with an Angelchik device, and it was grasped by the tail and removed from the left upper quadrant through the Hasson port without difficulty. Inspection of the surgical field revealed excellent hemostasis.

Pneumoperitoneum was taken down under direct vision as the ports were removed. Port sites were irrigated and re-anesthetized, and the fascia at the Hasson site was closed with a 0 Vicryl employing 3 interrupted sutres. The skin was closed with a 4-0 Monocryl and sealed with skin glue.

Thank you so much for all your help:)

Medical Billing and Coding Forum

Laparoscopy with evacuation of peritoneal clot after prostatectomy

Posted on February 26, 2018 by CPC Exam Medical Coding Updates

Any help with coding the following would be greatly appreciated. We were thinking that 49329 was the correct code but was not sure what to benchmark it to.

preoperative diagnosis: Postoperative intraperitoneal bleed after prostatectomy
Postoperative diagnosis: Same as preoperative
Procedure performed: Laparoscopy with evacuation of intraperitoneal clot (700 mL)
Ligation of bleeding incisional blood vessel and reclosure of midline extraction site.

He was brought to the operating suite and given a general anesthesia and IV Ancef. He was prepped and draped in sterile fashion in a supine position.
His Foley catheter was left in place and his urine was a light pink in color. I then removed the Dermabond and cut the sutures at his port sites in the right uppermost assistant port as well as the right mid port and left mid port. 12 mm ports were placed in each of these and the 10 mm camera with 0Deg lens was used to visualize the peritoneum. A total of 700 mL of clot was evacuated throughout the procedure.
On visualization of the anastomosis there was some old small clot adherent to this but it did not look to be the source of the bleeding. There was some old blood in the right lower pelvis more so than the left lower pelvis. On inspection of the abdominal wall there was a consistent steady dripping of blood from the midline incision port site. It was not heavy but rather a dripping but it was constant. This was thought to be the source of the bleeding.
We then opened the umbilical incision site and oversewed the fascia muscle and peritoneal lining with a #1 looped PDS suture and took wider bites on the fascia and tissue. After completely closing it we then looked back through the ports and there was no further bleeding from the site either from the abdominal side externally or the internal side. The rest of the port sites were visualized as each port site was extracted and there was no bleeding from night these either. The blood appeared to have stopped.
He was kept in Trendelenburg position throughout the procedure in order to help move the bowel away from the pelvis. I did put some Surgifoam and Surgical down in the pelvis. there is no further blood welling up and the surgical sites were all closed using 4-0 Monocryl subcuticular suture and Dermabond was placed on the skin. I did leave a #10 flat Jackson-Pratt drain coming out the left lower quadrant and sutured the skin with a 2-0 silk.

Medical Billing and Coding Forum