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Sep 7th, 2012 - ksch2140

Ureteroureteral Anastomosis due to Intraoperative Ureteral Injury

How would you code (CPT® & ICD-9)
PREOPERATIVE DIAGNOSIS: Intraoperative ureteral injury.
POSTOPERATIVE DIAGNOSIS: Intraoperative ureteral injury.
PROCEDURES:
1. Double J stent placement.
2. Ureteroureteral anastomosis.
3. Temporary drain placement.
This is a woman upon which Dr. Davis was operating. He was performing a total abdominal hysterectomy and transected the right ureter near the insertion into the bladder. Upon inspection the distal portion of the ureter inserting to the bladder was visualized. On the right lateral pelvic wall the ureter could be traced out under the peritoneal lining and upon elevation the proximal portion of the ureter was visualized. This was followed out to the proximal portion. This portion of the ureter appeared to be involved in the pedicle from the right side that had been transected. Sutures were removed and prompt flow was seen out the distal end of the ureter. The ureter itself did not appear to have any other injuries to it. A double J stent was brought into the surgical field and initially the guidewire was advanced into the proximal portion of the ureter. The stent was then placed over the guidewire and then slid into position. After removal of the guidewire there was flow. Next, the distal end of the double J stent was fed into the bladder. This showed good approximation of the ureter with no tension at all. Next, 3-0 chromic and RV1 needle was used in a simple interrupted fashion to make the anastomosis. No tension was applied. No urinary leakage was apparent. No bleeding was seen. Next, a ΒΌ inch Hemovac drain was placed in the pelvis with the catheter exiting out in the right groin region. This was secured in place with 0 silk
suture. The patient tolerated this part of the procedure well. Dr. Davis had the rest of the dictation.
I have found CPT: 50760, 53502
ICD-9: 56.82, 58.44, 59.8
I don't know if any of these are appropriate. Any help would be appreciated.



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