Viola Posted Tue 06th of July, 2010 15:19:20 PM
I am billing 51865 (cystorrhaphy). Per op note below, are there additional codes I could bill? 74430? 51600?
The Urology Service was called intraoperatively for evaluation of a bladder injury. During dissection of the colon off the posterior surface of the bladder, there was an inadvertent injury into the bladder. This was a difficult dissection secondary to radiation therapy to the pelvis and prior surgeries. It was approximately 3 to 4 cm long on the posterior aspect of the bladder. Upon inspection of the bladder, there appeared to be no injury to the ureters. Indigo carmine dye was administered intravenously and clear blue urine was seen effluxing from both the right and left ureteral orifice. Therefore, a 2-0 Vicryl stay suture was placed on the most superior and inferior portion of the cystotomy. Then, using a 3-0 Vicryl, the detrusor muscle and urothelium were closed in a running fashion to close the cystotomy Then, a second layer of interrupted figure-of-eight 3-0 Vicryl sutures were used to cover the suture line. A 20-French Foley catheter was then placed into the bladder and 10 cubic centimeters of preservative-free normal saline was instilled into the balloon. Then, a gravity cystogram was performed and after instillation of 150 cubic centimeters of saline, there was no evidence of a leakage from the bladder, thus this was a watertight closure. The peritoneum was then placed over the 2 suture lines using interrupted 3-0 Vicryl sutures. At the conclusion of the urology portion of the procedure, there was clear urine draining form the bladder. Once again, a gravity cystogram was performed and it was found to be watertight. A 10 mm flat JP drain was left in the pelvis and secured to the skin with a 3-0 Nylan suture. We then turned the surgery over to the colorectal surgeons, who will dictate a separate operative note and EPR. There were no immediate intraoperative complications for the urology portion of this procedure.