http://www.supercoder.com/forum/ Supercoder - Ask an Expert? Tag: small bowel obstruction - Recent Posts en Sun, 12 Feb 2012 12:30:26 +0000 http://www.supercoder.com/forum/topic/please-help-coding-op-note#post-1222 Thu, 15 Jul 2010 14:16:20 +0000 Anonymous 1222@http://www.supercoder.com/forum/ <p>In this procedure the physician is performing a lysis of adhesion so I think we can go with only 44005. </p> http://www.supercoder.com/forum/topic/please-help-coding-op-note#post-1221 Wed, 14 Jul 2010 22:47:42 +0000 Donna Newton 1221@http://www.supercoder.com/forum/ <p>Would appreciate advice on coding op note below:</p> <p>The patient was placed on the operating table in the supine<br /> position. After adequate general anesthesia was secured, the abdomen was<br /> prepped and draped in the usual fashion. A Foley catheter had been placed<br /> preoperatively, as well as SCD hose. The patient has had a gram of Mefoxin<br /> as well. A midline incision is made removing upper midline scar and carried<br /> out around the umbilicus. The fascia is noted to be markedly thickened. On<br /> entering the peritoneal cavity, the bowel is noted to make up a large<br /> phlegmon with edema between loops of bowel and edematous mesentery. Once<br /> pelvic adhesions tethering this mass of bowel are lysed, we then elevated<br /> this bowel mass and began with lysis of adhesion. We started at the ileum.<br /> There were numerous adhesions between loops of bowel, as well as intra loop<br /> adhesions, also adhesions involving the mesentery. We noted a single loop of<br /> jejunum adherent to the anterior abdominal wall below the umbilicus. This<br /> was a hairpin turn of small bowel and felt to be the source of her partial<br /> small bowel obstruction. We continued lysing adhesions until all adhesions<br /> were lysed from the ileum to the ligament of Treitz. We did note the<br /> jejunojejunostomy anastomosis was intact. The jejunum did pass through the<br /> transverse mesocolon to be anastomosed to the stomach. This portion of the<br /> jejunum wall was edematous, but there was no evidence of ischemia throughout<br /> close examination of her bowel. We did have two areas where the seromuscular<br /> layer had been torn. This was closed with horizontal sutures of 3-0 silk.<br /> We did not incur any inadvertent enterotomies. At the conclusion of the<br /> procedure, we copiously irrigated the abdomen with normal saline and at this<br /> point placed Seprafilm within the pelvis, then allowing small bowel contents<br /> to return to their normal anatomic position, we placed additional Seprafilm<br /> just superficial to the returned small bowel. We then pulled omentum over<br /> this and as well placed Seprafilm on either side of the abdominal cavity, as<br /> well as in the midline. Thus, we used approximately five pieces of Seprafilm<br /> and at this point two retention sutures were placed of #2 Ethilon. The<br /> fascia was then closed with running suture of #1 Prolene. These met in the<br /> middle. We tied these and then closed the skin with staples. The retentions<br /> were then tied over bridges. Dressing placed, as well as abdominal binder<br /> and the patient was transferred to the recovery room in stable. Estimated<br /> blood loss was approximately 100 to 150 cc. She tolerated the procedure well. </p>