1. VIOLA BROWN
   Member
   Posted 1 year ago #
   

   The new umbilicus was created prior to completion of closure by raising a V-shaped flap. This was taken down to the fascia. The tubes were brought up through this incision and the fascia. The skin was sewn down to the fascia and then a fatty tissue over this was approximated using sutures of 5-0 Maxon. The umbilicus itself was matured. The tubes were sewn to the skin using 3-0 nylon suture. The stents were taped to the suprapubic tubes using Steri-Strips over Benzoin. Once baby was placed in traction, baby was transferred and intubated to the pediatric intensive care unit. Blood loss was noted to be minimal. The x- ray demonstrated good approximation of the pubic rami. Procedure took approximately 4-1/2 hours to accomplish. The patient was in stable condition at the end of the procedure.

2. Suzanne Leder
   Member
   Posted 1 year ago #
   

   Hi Viola,

   Could you send the entire op note and the indication for the surgery?

   Suzanne Leder, BA, M.Phil., CPC, COBGC
   Executive Editor of the Ob-gyn Coding Alert,
   Orthopedic Coding Alert, and Otolaryngology Coding Alert

3. VIOLA BROWN
   Member
   Posted 1 year ago #
   

   Title of Operation:
   Closure of bladder exstrophy and umbilicoplasty.

   Indications for Surgery:
   The patient is a newborn with newborn, who is less than 72 hours of age, presents with classic bladder exstrophy which was evaluated and found to be adequate size for closure. The patient has been brought in for operative closure.

   Preoperative Diagnosis:
   Newborn with bladder exstrophy.

   Postoperative Diagnosis:
   Newborn with bladder exstrophy.

   Anesthesia:
   General.

   Specimen (Bacteriological, Pathological or other):

   Prosthetic Device/Implant:

   Postop Condition: Stable.

   The patient brought to the operating room, placed in the supine position on operating table. A PICC line was placed by the PICC team. Additionally, a caudal catheter was used to provide additional local analgesia. The entire baby was prepped and draped all the way from just down to lower extremities. At this time, a circumscribing incision was made around the bladder plates including the umbilicus. The bladder was dissected off the anterior abdominal wall. This dissection was carried down towards the area of the bladder neck and pelvic floor. Fibers were divided to allow the bladder to drop well into the baby's pelvis. A 5-French ureteral catheter was placed and location confirmed using retrograde ureteral pyelograms. At this time, these catheters were flexed to the ureteral orifices and brought out through separate stab incisions in the bladder template. Additionally, a 12-French Malecot was placed in the bladder. This tube was brought out through the separate stab incision of the upper end of the bladder. Once dissection at the inferior aspect was carried on to the shaft of the penis including the bladder neck and prostatic urethra. The bladder closure was now begun. The bladder was closed using interrupted figure-of-8 sutures of 3-0 Vicryl. An additional imbricating suture of 3-0 Vicryl was used as the second layer of closure of the bladder. The distal aspect of the bladder recreated a near urethra at the base of the penis. This was created around a 14-French sound, so as to catheterize easily with a 14-French sound. The stents were now noted to be draining well. The suprapubic tube site was closed using a pursestring suture of 3-0 Vicryl. At this time, the bladder was dropped into the abdomen. The pubic rami were dissected out completely. The inguinal canals were checked to see whether they were inguinal hernias. Hernia was noted on the left hand side. This was a relatively small hernia, which was tied off using a 5-0 Maxon suture. No hernia was noted on the right hand side. The pubic rami were now approximated using a #2 nylon suture. To do this, the bladder was pushed down into the pelvis where it usually belongs. A suture was passed and the knot tied on the superior aspect of the pubic rami and once this knot was tied, the pubis was noted to be completely approximated. An additional #2 nylon suture was taken through the inferior edge of the rectus on both sides and tied and placed well. The fascia was now approximated over this using interrupted sutures of figure-of-eight 3-0 Vicryl, subcutaneous tissue was approximated over this using 4-0 Vicryl. The skin was closed using interrupted sutures of 4-0 nylon at the level of the urethral meatus. This was brought up through the skin and sewn in place using interrupted sutures of 5-0 Maxon. The urethral meatus was noted to be easily catheterize using a 10-12 French catheter. The extremities were brought together. At this time, the orthopedic surgeon came in placed the baby in traction. A dressing of Gelfoam gauze and Tegaderm was applied over incision. The new umbilicus was created prior to completion of closure by raising a V-shaped flap. This was taken down to the fascia. The tubes were brought up through this incision and the fascia. The skin was sewn down to the fascia and then a fatty tissue over this was approximated using sutures of 5-0 Maxon. The umbilicus itself was matured. The tubes were sewn to the skin using 3-0 nylon suture. The stents were taped to the suprapubic tubes using Steri-Strips over Benzoin. Once baby was placed in traction, baby was transferred and intubated to the pediatric intensive care unit. Blood loss was noted to be minimal. The x- ray demonstrated good approximation of the pubic rami. Procedure took approximately 4-1/2 hours to accomplish. The patient was in stable condition at the end of the procedure.

4. VIOLA BROWN
   Member
   Posted 1 year ago #
   

   Per your request, I added the complete op note. Still waiting for a response. Thank you. -Viola

5. Suzanne Leder
   Member
   Posted 1 year ago #
   

   Hey Viola,

   Got Melanie Witt's response today:

   "Dx code is 753.5. Possible CPT code are 51800, 54390, 51940, but I believe that 54390 is the most complete code to use. 51940 bundles to 54390 and 51800 is an inherent part of repair of the epispadias. If we knew the weight of the baby modifier -63 may be appropriate. I don't think 4 hours is unusual for this type of procedure.... lots of work, but usual so a modifier -22 would not be warranted.

   Melanie"

RSS feed for this Question

Reply

You must log in to post.