Forum - Questions & Answers

Feb 26th, 2014 - buchanan66

Lysis of adhesions with partial omentectomy

I am having trouble coding this surgery...can you please help me out with the code/codes? I keep coming up with an unlisted code and MC is saying its not billable. Thank you...

PREOPERATIVE DIAGNOSIS: ACUTE CHOLECYSTITIS.
POSTOPERATIVE DIAGNOSIS: OMENTAL INFARCT ADHERENT TO
THE RIGHT UPPER QUADRANT
PARIETAL PERITONEUM.
PROCEDURE: 1. EXPLORATORY LAPAROSCOPY.
2. DISSECTION OF INFLAMMATORY
ADHESIONS AND PARTIAL
OMENTECTOMY VIA THE
LAPAROSCOPE.

NARRATIVE: The patient underwent satisfactory Iodophor prep and induction of general anesthesia. A 1 cm
incision was made inferior to the umbilicus and the Veress needle was introduced and a satisfactory CO2
pneumoperitoneum was created at 15 cm of pressure. The 10 mm port was introduced without difficulty and the
scope was placed. The omentum was adherent to the right upper quadrant parietal peritoneum at its juncture with the
falciform ligament. Two 5 mm ports were placed laterally under direct vision and the omental adhesion was taken
down. The end portion of the omentum appeared to have been infarcted causing the adhesions. More adhesions
were taken down and it was decided to thoroughly explore the abdomen. The stomach was exposed on the anterior
surface there was no evidence of inflammation or perforation. The gallbladder was exposed without directly
grasping the gallbladder it appeared to be normal throughout flank without any inflammation or adhesions. The
appendix was visualized in a retroperitoneal position. The terminal ileum appendix and the terminal cecum also
appeared normal. There was no evidence of inflammation in other places in the abdomen. Attention was then turned
to the infarcted piece of omentum this was resected using the hook electrocautery and removed piecemeal through
the 10 mm port. Some was submitted pathologic diagnosis and another was submitted for culture. Some of the
inflammatory adhesions were bleeding and this was controlled with electrocautery. The ports were removed under
direct visualization and there were no port site bleeding after placing 20 ml of Marcaine in the subhepatic space.
The umbilical and xiphocostal 10 mm incisions were closed with interrupted 2-0 Vicryl and all four skin incisions
and the deep fascia were injected with 0.5% Marcaine. The skin was closed with skin staples and the patient
appeared to tolerate the procedure well and was sent to the recovery room in satisfactory condition



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