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Suzanne Posted Fri 01st of April, 2016 11:55:11 AM

We have an interesting case. The patient presented with intermittent small bowel obstruction and a large ovarian cyst. She has a history of recent bowel resection, multiple previous abdominopelvic surgeries and significant pelvic pain.
Via laparascope, the surgeon noted: "the small intestine itself appeared to be unremarkable except at one point the loop of bowel that had been resected and anastomosed was noted to have another loop of bowel adherent to it. Above which, the intestine generally appears to be dilated..." After freeing up space a rt lower quadrant 5 mm trocar was able to be placed. The surgeon then proceeded to lyse adhesions through out the pelvis, freeing up the omentum entirely from the ant abd wall, then placing a 3rd suprapupic 10 mm trocar. More adhesions were lysed including RT colon and cecum. (appy was done). Finally, reaching the complex cystic ovarian mass, dissection of the RT adnexa was done and placed into an Endopouch along w appendix.
After irrigation "further lysis of adhesions was carried out and at this point we began running of the small bowel. Starting with the ileocecal area, the intestine was carefully inspected. At mid point, previous surgery site was noted. The two loops of small bowel were adherent to this area, which were taken down with surgical sharp dissection. This was uneventful. We further inspected the intestine to the ligament of Treitz and this was unremarkable."
The case was then turned over to another surgeon who repaired large ventral hernia, and who also assisted in the entire case.

So, the majority of this case was spent lysing adhesions. Particularly freeing up the obvious stricture above the previous anastomosis site.
Can I code 44615 with 58661? These are not bundled. Or should I use 44180-22 for the appy and removal of ovarian cyst and adnexa. Obviously, either way I must send notes since I would have to use an unlisted scope code for 44615.

Would really appreciate your expert judgement on this case. I don't want to "over code", but 44615 seems to fit the procedure. Thanks so much.

SuperCoder Answered Mon 04th of April, 2016 02:17:48 AM

Yes, even I think you should code 44615 with 58661, as this covers the scenario you have narrated above. However, please check your payer preference before finalizing on the codes. Thanks.

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