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Tag Archives: Peritoneal

Laparoscopic removal of peritoneal dialysis cath

Posted on by
Can’t find a code for Laparascopic removal of cath … can someone direct me … so far I have codes 49421, 49084, please correct me if incorrect :confused:

PREOPERATIVE DIAGNOSES:
Fungal peritonitis with peritoneal dialysis catheter and chronic kidney disease.

POSTOPERATIVE DIAGNOSES:
Fungal peritonitis with peritoneal dialysis catheter and chronic kidney disease.

PROCEDURES:
Laparoscopic removal of peritoneal dialysis catheter and abdominal washout with
placement of hemodialysis catheter tunneled.

ASSISTANT:
None.

ANESTHESIA:
General.

PROCEDURE IN DETAIL:
The patient was placed on operating table in supine position. After
administration of general anesthesia, the patient’s abdomen and chest were
prepped and draped in usual fashion. Attention was turned to the left
subclavian approach utilizing an infraclavicular approach subclavian vein was
easily cannulated. J-wire introduced. Peel-away dilator catheter was placed
over the J-wire into the vessel and the previously heparinized catheter was
placed in position through the peel-away catheter and anchored. There was good
blood return in both ports. A 7500 units in 2 mL of heparinized saline was
instilled in each port. Biopatch and sterile dressings were applied. Then,
attention was turned to the abdominal area where a supraumbilical midline
incision made and carried down the fascia. 0 Vicryl two stay sutures were
placed. The Hasson was placed. Laparoscope was then placed and a 5 mm trocar
was placed in the right lower quadrant without injury to intraabdominal
contents. The catheter was identified and easily removed early just by pulling
the catheter out and the entire catheter came out. The abdominal cavity was
then copiously irrigated with 6 L of fluid and then suctioned as well.

Cultures had been obtained from this fluid prior to the surgery. The area was
thoroughly irrigated, all fluid removed and then the fascia was closed with 0
Vicryl and staples for skin. Final sponge, needle, and instrument count
correct. Sterile dressings placed. The patient was transferred to recovery
room in satisfactory condition.

Medical Billing and Coding Forum

Takedown of falciform ligament & removal of peritoneal lining of umbilicus with open

Posted on by
Oh my. This case is giving me a headache. Any insight would be unbelievably appreciated.

…………….I made a 5 mm incision in the left upper quadrant through a previous incision site into the abdomen with a Veress needle, insufflated 14 mmHg, placed a 5 mm port. There was some adhesions down above the umbilicus, placed a port in the left lower quadrant and one in the right upper quadrant through previous incision sites, got in, took down those adhesions and then looked at the falciform ligament, we used a laparoscopic Metzenbaum to take down the falciform ligament, mobilizing it, placed a 22-gauge needle through the umbilicus, identifying which was then cleaned off the peritoneum in that area. Once that was done, we placed traction on the umbilicus, found a small fistulous tract and opened that track up with the Bovie as well. There was essentially no blood loss to speak of. We closed all wounds with running subcuticula sutures of 4-0 Vicryl and placed a sterile dressing in the umbilicus.

Medical Billing and Coding Forum

Laparoscopy with evacuation of peritoneal clot after prostatectomy

Posted on by
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

CPT CODE for Drainage of ascites through a peritoneal port

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Can anyone give us direction on which CPT code to use for a patient who comes in with an existing peritoneal port for drainage of ascites. This is the note:

Pt was placed in bedroom and positioned. Vitals taken. Site draped and was cleaned with iodine, alcohol and chlorhexidine. Peritoneal
port was accessed aseptically with no issues. Three liters removed via phlebotomy bottles with no issues. Vitals continuously
assessed. Pt deaccessed and observed for thirty minutes.

Medical Billing and Coding Forum