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57425 Laparoscopic Colposacropexy

SMS Posted Tue 23rd of September, 2014 12:42:14 PM

My physician did 57425 after the procedure it was noted that the rectum had been involved by suturing part of the mesh into the rectum. He then had to perform a exploratory lap and basicly had to undo what he had just done. I am at a loss as to how to code this. I know that I should not charge for exploratory lap. Please help!

SMS Posted Mon 29th of September, 2014 12:17:06 PM

Has anyone looked into my question?

SuperCoder Answered Tue 30th of September, 2014 07:46:05 AM

We apologize for a delayed response. Please explain in detail what surgical procedure did physician perform 'to undo what he had done'.
He had performed 57425 earlier which was reverted due to suturing of the mesh into the rectum, but in order to reply your query, we need more details on surgical procedure/s which were successfully completed before the end of surgery and only those should be coded.

And your are correct, exploratory lap should not be coded separately.

Thank you!

SMS Posted Tue 30th of September, 2014 16:52:28 PM

PREOPERATIVE DIAGNOSIS: Vaginal prolapse

POSTOPERATIVE DIAGNOSIS: Vaginal prolapse

PROCEDURE: Robotic colposacropexy, exploratory laparotomy with takedown of colposacropexy repair, proctoscopy, removal of foreign body from rectum, primary repair of rectal injury

ANESTHESIA: GENERAL

PROCEDURE IN DETAIL: Patient was taken to the operating room,
general anesthesia was induced. Patient was placed in low lithotomy
position. All pressure points were well-padded. Abdomen and genitalia
were prepped and draped in the usual sterile fashion. 16 French Foley
catheter was inserted and placed to gravity drain. A 5 mm Optiview port was placed in the left upper quadrant and access was obtained. The abdomen was then insufflated and there was no evidence of intra-abdominal injury. Skin incision was made just above the umbilicus in the midline with a skin knife.
After this, a 12 mm trocar was placed through
this area and then the laparoscope was introduced. Another 12 mm trocar was placed
superior and lateral on the left. The cold scissors were used to take down some adhesions in the right lower quadrant An 8 mm was placed inferior and lateral on the left. Two 8 mm's were placed inferior and lateral on the right.
Robot was brought to the table, docked to the trocars. An EEA sizer was placed in the vaginal vault and used to identify the cuff. Peritoneum overlying the cuff was incised transversely. There was noted to be significant scarring around the vaginal cuff from her previous hysterectomy which made dissection difficult.Bladder was freed
off of the vaginal cuff.
After cuff had been exposed, a suitable piece Y-mesh was selected. The anterior aspect was secured with 8 interrupted 2-0 Gore-Tex sutures. Posterior limb was secured likewise with 6 interrupted 2-0 Gore-Tex sutures. Sacral promontory was identified, peritoneum overlying that was incised. Dissection was carried down to the periosteum to allow placement of the mesh to be anchored. Incision was made from this down the
peritoneum to allow the mesh to be covered with peritoneum. The mesh was
secured with two interrupted 2-0 Gore-Tex sutures after being cut to the
appropriate length.

Wound was thoroughly irrigated. Hemostasis was excellent. The peritoneum was closed over the mesh with running 3-0 V-lock suture. Wound was thoroughly irrigated and hemostasis was
excellent. Robot was undocked from the trocars, pushed out of the way.
Two 12 mm trocar sites were closed with 0 Vicryl using a Carter Thompson device. Abdomen was desufflated. Trocars were removed. Skin at the two 12 mm sites was closed with interrupted 4-0 Vicryl subcuticular stitches.
Steri-Strips were applied.

After the drapes were taken down, it was noted that there was serosanguineous drainage from the rectum as well as a missing portion of the latex condom from the O'Connor drape that had been in the rectum. On rectal exam it was noted that this piece was palpable and proctoscopy was performed. There was noted to be sutures in place indicating that the rectum had been involved in the previous repair. At this point I elected to perform an exploratory laparotomy and the patient was reprepped and draped. I went and updated the family on the findings at this point and answered all questions. We then made a low midline incision through her previous hysterectomy scar. Dissection was carried down with electrocautery through the subcutaneous tissue and the rectus fascia was entered in a controlled manner. I then obtained access into the peritoneum. The Bookwalter self-retaining tractor was utilized to a with exposure. Once the peritoneal closure had been opened, I was able to visualize the mesh and at this point it was noted that the mesh had been sutured at least partly to the rectum. The Gore-Tex sutures were then removed from both the sacral promontory as well as the anterior and posterior limbs of the mesh. At this point, an assistant was able to retrieve the foreign body from the rectum without difficulty. There did appear to be some small injuries to the rectum and Dr_____ was asked for an intraoperative consultation. Please see his operative note for full details. He performed a primary closure of the area utilizing insufflation of the rectum to ensure an airtight closure. Once he finished his portion of the procedure, I then removed the retractors and closed the rectus fascia with 2 running #1 looped PDS's. Skin clips were applied as well as a sterile dressing.

SuperCoder Answered Wed 08th of October, 2014 01:07:44 AM

The presented issue is termed as surgical error. Unfortunately, CMS doesn't pay for surgical errors. You may go through this MLN article for more details.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm6405.pdf

Hope this answers your query

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