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Tag Archives: resection

Resection of large intra-abdominal cyst along with left neprectomy

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I am having trouble finding the correct cpt codes to use for the following surgery:

Operation: Exploratory laparotomy, resection of large left-sided intra-abdominal cyst along with left nephrectomy, closure of enterotomy.

Description of Operative Procedure:
With the patient on the operation room table in the supine position, a 16 French Foley catheter was place for 200 ml amber urine; then, the abdomen was shaved, prepped and draped in the usual sterile fashion. A xiphoid to pubis mid-line abdominal incision was made and carried through into the peritoneum. Retractors were placed, and the cyst was gradually freed from the surrounding tissue with a combination of blunt and sharp dissection. The gonadal vessels were doubly ligated between 0 silk ties and divided in order to free up the medial aspect of the cyst. The transverse mesocolon was incised with the harmonic scalpel in order to expose the left renal fossa. It became obvious that the cyst was intimately associated with the left kidney, and as the latter appeared to be end-stage, we elected to remove the kidney en block with the specimen. Accordingly, the left renal vein was doubly ligated with 0 silk ties and suture-ligated with a 2-0 silk tie prior to dividing. The left renal artery was double=y tied with 0 sild ties and divided, and then the harmonic scalpel was used to divided the remaining attachments; the specimen was then removed.

A 2 cm tear was noted along the antimesenteric border of the distal transverse colon. A small serosal avulsion was repaired by including this in the enterotomy closure with the TA-55 stapler, and then the enterotomy site was imbricated with interrupted 2-0 silk lambert sutures. The abdomen was closed with interrupted 0 vicryl suture and the skin was loosely closed with the stapler.

Any ideas?

Medical Billing and Coding Forum

Please help code Ulcer resection and aneurysmectomy off/at AV fistula

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DX: Right arm AV fistula with ulceration and aneurysm in the setting of end stage renal disease.

Operation performed:

1. Aneurysmectomy of the right upper extremity AV fistula aneurysm.
2. Ulcer resection of this ulceration of the skin in the right upper extremity.
3. Aneurysmorrhaphy and aneurysmectomy with ulcer resection.

Indications for procedure: t
This is a patient, who has right upper extremity AV fistula and he then has had aneurysmal disease dilatation in _____ segments as well as an ulceration of the skin that is at risk of rupturing.

Procedure:
The patient was appropriately consented and brought to the operating room, prepped and draped in sterile fashion. Right upper extremity was prepped in sterile field. Infusion of lidocaine anesthetic was infused around the larger of the 2 masses and an encompassing separation of the ulceration from the AV fistula took place. Sharp elliptical incision was made around the larger of the 2 masses _____ was made, carried around the proximal and distal portions of the AV fistula and the ulceration was resected, sent off to pathology. The same was done for the aneurysm. Aneurysm was encircled proximally and distally. There was control that was made and a subsequent aneurysmectomy took place with aneurysmorrhaphy using running 6-0 prolene suture as well as a endo-gia stapler _____ . After the case, there was a good thrill through the fistula and good hemostasis and the fistula was in good shape and much more _____ caliber and size postprocedure. the patient tolerated the procedure well. A running 3-0 nylon was used to close the suture.

Medical Billing and Coding Forum

Please help code Ulcer resection and aneurysmectomy off/at AV fistula

Posted on by
DX: Right arm AV fistula with ulceration and aneurysm in the setting of end stage renal disease.

Operation performed:

1. Aneurysmectomy of the right upper extremity AV fistula aneurysm.
2. Ulcer resection of this ulceration of the skin in the right upper extremity.
3. Aneurysmorrhaphy and aneurysmectomy with ulcer resection.

Indications for procedure: t
This is a patient, who has right upper extremity AV fistula and he then has had aneurysmal disease dilatation in _____ segments as well as an ulceration of the skin that is at risk of rupturing.

Procedure:
The patient was appropriately consented and brought to the operating room, prepped and draped in sterile fashion. Right upper extremity was prepped in sterile field. Infusion of lidocaine anesthetic was infused around the larger of the 2 masses and an encompassing separation of the ulceration from the AV fistula took place. Sharp elliptical incision was made around the larger of the 2 masses _____ was made, carried around the proximal and distal portions of the AV fistula and the ulceration was resected, sent off to pathology. The same was done for the aneurysm. Aneurysm was encircled proximally and distally. There was control that was made and a subsequent aneurysmectomy took place with aneurysmorrhaphy using running 6-0 prolene suture as well as a endo-gia stapler _____ . After the case, there was a good thrill through the fistula and good hemostasis and the fistula was in good shape and much more _____ caliber and size postprocedure. the patient tolerated the procedure well. A running 3-0 nylon was used to close the suture.

Medical Billing and Coding Forum

Bladder Tumor Resection and Ureteral Stent placement

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Can someone please offer guidance?
My provider performed transurethral resection of bladder tumor that invaded the ureteric orifice. He inserted a stent to "facilitate drainage".
NCCI Edits bundle the two procedures together, is it appropriate to unbundle them in this scenario?

"The patient had a large, approximately 3-4 cm papillary bladder tumor on his right lateral wall, obscuring the identification of his right ureteral orifice. This was resected sequentially down to muscle. The right ureteral orifice was identified and it was not the source of the tumor, but did appear to have some involvement of papillary tumor at the orifice. The right ureteral orifice was resected and sent as a separate pathologic specimen. Given the resection, we placed a ureteral stent on this side to facilitate drainage and also assist future resections."

52332-59-RT
52335

Thanks in advance…

Medical Billing and Coding Forum

Orbital rim implants s/p cancer resection

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The doctor put in two orbital implants and attached them to previously placed plates in patient’s eye orbit. The doctor wants to bill 67550 twice, since he put in two implants. However, I do not believe that this is quite correct since they were both done on the same eye and no separate incision was made. Any suggestions????

Medical Billing and Coding Forum

osteoclasis resection arthroplasty

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I need some help with this one. I’m looking at the partial excision of bone, since this doesn’t make mention of any previous fractures, I cannot use the non union or malunion repairs. Any help or advice is appreciated!

OP note:

A scalpel was used to make a longitudinal incision on the dorsal aspect of the 4th and 5th webspace. Disection was deepened through the fat, and bleeding points were coagulated. The extensor tendon of the 5th toe was identified and transected. There was a florid synovitis, which I excised. I then used the oscilating saw to resect the distal portion of the metatarsal shaft and after this a more through plantar synovectomy was performed. After cleaning out the joint, and having already resected the bone under fluoroscopic guidance, I completed the procedure by placing a pin from a proximal to distal direction, 0.45 kirschner pin out through the base of the proximal phalanx and into the tip of the toe. After confirming proper placement, I then in a distal to proximal direction placed a pin into the medullary canal of the 5th metatarsal shaft. after obtaining 3 view xrays showing intramedullary location of the fixation and clinically feeling the toe was well aligned, I completed the procedure by lavaging the wound.

Medical Billing and Coding Forum

Metatarsal Head Resection VS. Amputation

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Can someone take a look at this report? The doctor picked an amputation code for this procedure, then states he only excised the metatarsal head. Thanks!

Following satisfactory placement of the patient supine on the operating table satisfactory timeout was accomplished, satisfactory general anesthesia was induced by Dr. taken, and sterile prep and drape of the left lower extremity was accomplished. The left first metatarsal head had osteomyelitis and an underlying plantar ulcer. As such a 3-1/2 cm longitudinal incision was made with a 15 blade overlying the metatarsal head and distal shaft of the metatarsal. The incision was carried down through the subcutaneous tissues down onto the metatarsal shaft and carried through to the metatarsal head. Dissection proceeded to free up the metatarsal and then a micro-oscillating saw was used to transect the metatarsal shaft at the distal third. Once transected the metatarsal shaft was grasped with a towel clip was a brittle bone and it splintered. But with a grasping elevation was accomplished away from the underlying soft tissues in the plantar surface along with tenderness insertions and these were debrided and excised the sesamoid bone was also identified and excised. The metatarsal head was separated from the proximal great toe at the joint space. The proximal area of the first metatarsal shaft was sent for culture and the metatarsal head was sent for culture and pathologic examination. The sesamoid bone was also sent for culture and for pathologic examination. Following this the surgical bed was irrigated with saline and then closed with 3-0 Monocryl for the subcutaneous tissue after satisfactory hemostasis and the skin was closed with interrupted 4-0 Prolene sutures. Sterile dressing Kling and Ace wrap was applied. Patient tolerated procedure well was taken to recovery room in stable condition.

Medical Billing and Coding Forum

head resection code

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I need help coding a note, I think it should be 28140 and 20240 co worker thinks it should be 20240, 28111, and 13160. Any help please?

PROCEDURES:
1. First metatarsal head resection, left foot.
2. Bone biopsy of first metatarsal, left foot.
3. Layered closure of surgical wound, left foot.

MATERIALS: Gelfoam, 3-0 Vicryl and staples.
DRAIN: Jackson-Pratt drain.
SPECIMENS: Metatarsal head and bone biopsy of first
metatarsal.
ESTIMATED BLOOD LOSS: Less 50 mL.
COMPLICATIONS: None.
TECHNIQUE: After reviewing the patient’s history and physical and noting no significant changes since the patient’s last visit, the patient was brought to the operating room and placed on the operating table in supine position. In the presence of surgeon’s assistants, anesthesiologist, and nurses, a time-out was called to verify the patient’s name,procedure to be performed, and side on which it was to be performed. All present were in agreement. Following adequate IV sedation, a local anesthetic block was administered to the patient’s left foot in a standard Mayo-type fashion utilizing a total of 10 mL of 1% lidocaine plain. The patient’s foot
was then scrubbed, prepped and draped in the usual aseptic manner. Attention was then directed to the patient’s left foot where a previous hallux amputation was performed. Utilizing a hemostat, remaining staples were removed from the incision. The incision was opened and inspected. There was noted to be no devitalized tissue or purulence at this time. At this point, utilizing a sagittal saw, the first metatarsal head was resected and passed from the surgical field. It was sent
for pathology. The distal portion of the remainder of the first metatarsal was then resected with a rongeur and bone-cutting forceps and passed from the surgical field to be a clearance cut to rule out osteomyelitis. At this point significant bleeding was noted, which had not been noted on previous surgeries. No purulence was noted or devitalized tissue. Pulse lavage was then carried out utilizing 1 liter of saline mixed with antibiotics, followed by an additional liter of plain saline. Any redundant or devitalized tissue was resected, including both tibial and fibular sesamoid. The skin was then remodeled. Prior to closure of the wound, significant bleeding was noted. A Jackson-Pratt drain was placed along with Gelfoam. The deep structures were reapproximated with 3-0 Vicryl. Skin was reapproximated with staples. Adequate control of bleeding was noted with the drain in place. The foot was then cleaned and dressed utilizing antibiotic ointment, Owens silk, 4 x 4’s,
Kling, and an Ace wrap. The patient tolerated the above procedure and anesthesia well and was transferred from the operating room to the PACU with
vital signs stable and neurovascular status intact to the left foot.

Medical Billing and Coding Forum