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CPT help please

Lynn Posted Wed 05th of October, 2016 07:27:20 AM
POSTOPERATIVE DIAGNOSIS: Metastatic recurrent cervical cancer.   PROCEDURE PERFORMED: Exploratory laparotomy, lysis of adhesions, biopsy of small bowel nodules, resection of left pelvic sidewall nodal metastasis, partial omentectomy, and repair of 6 separate ventral hernias in the incision line. A vertical midline incision was made beginning cephalad to the suprapubic catheter. The incision was extended around the umbilicus and into the upper abdomen. Numerous hernia sacs were encountered, some of which had omentum *** them and they were of a size that could have easily trapped small bowel, although no small bowel was in the hernia sacs at the point of the incision. Once the abdomen was entered, the abdomen was explored with findings as noted. The adhesions of omentum into the cul-de-sac were carefully taken down using electrosurgery with the LigaSure Maryland bipolar vessel sealing device. Once adequate exposure of pelvis was attained, it was apparent that she had 2 worrisome nodules on the pelvic sidewall and several worrisome nodules on the distal ileum which appeared very pale and very scarred from radiation effect. The mesenteric nodules were removed as 5 separate specimens first using sharp dissection and these were submitted for frozen section. Frozen section on all of these sites was consistent with fibrosis and showed no evidence of malignancy. The nodal disease on the pelvic sidewall was carefully dissected free using a scalpel due to dense adherence to underlying vascular, neuro, and ureteral structures. The specimens were submitted separately. Both of these sites were consistent with metastatic disease. While awaiting the frozen section, portions of the left pelvic sidewall were also opened and it was apparent that tumor extension was very close to the inferior lateral border of the symphysis pubis on the left. Once the frozen section diagnosis confirmed metastatic disease, the procedure that was planned (total pelvic exenteration) was discontinued.   The omentum had a band-like adhesion that was considered a risk for bowel entanglement. Therefore, the omentum was mobilized and a portion of it was removed so that no potential risk to bowel would be left behind. Packs and retractors were then removed and the abdomen was irrigated.   The 6 different ventral hernia sites were individually resected. Several of which were submitted as a single specimen. Fascial edges were freshened. The abdominal wall was tested and primary closure with no tension was easily attainable. The abdominal wall was therefore closed with a #1 PDS looped suture using a Smead-Jones technique. Every third stitch was reinforced with a simple mass stitch using #1 Prolene. Subcutaneous adipose was irrigated and a Jackson-Pratt drain was placed in the subcutaneous tissues. Deep dermal stitches with 2-0 Vicryl were placed. Skin was closed with a running subcuticular stitch using 4-0 Monocryl. Final sponge, needle, and instrument counts were correct at the completion of the procedure.   Would the codes for this be 58957 and 49560 x6?  
SuperCoder Answered Thu 06th of October, 2016 05:03:28 AM

AAE does not provide coding for operative reports and chart notes.

 

SuperCoder offers SuperCoding on Demand (SOD) (http://www.supercoder.com/coding-answers/coding-on-demand) for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail customerservice@supercoder.com for more information.

Lynn Posted Thu 06th of October, 2016 06:01:08 AM
My doctor did an exploratory laparotomy, lysis of adhesions, biopsy of small bowel nodules, resection of left pelvic sidewall nodal metastasis, partial omentectomy, and repair of 6 separate ventral hernias in the incision line. Would CPT codes be 58957 and 49560x6?
Lynn Posted Thu 06th of October, 2016 12:27:11 PM
I forgot to mention that the DX is metastatic cervical cancer.
SuperCoder Answered Fri 07th of October, 2016 08:00:25 AM

Hi, our team is working on it and will get back to you. 

Lynn Posted Sun 16th of October, 2016 12:52:03 PM
Are you still checking into this? The DX is metastatic cervical cancer. My doctor did an exploratory laparotomy, lysis of adhesions, biopsy of small bowel nodules, resection of left pelvic sidewall nodal metastasis, partial omentectomy, and repair of 6 separate ventral hernias in the incision line. Would CPT codes be 58957 and 49560 x 6?
SuperCoder Answered Mon 17th of October, 2016 06:55:57 AM

Hi,

As per documentation CPT 58957  for exploratory laparotomy, lysis of adhesions, biopsy of small bowel nodules, resection of left pelvic sidewall nodal metastasis, partial omentectomy is correct. CPT 49560 will be coded only once for repair of 6 separate ventral hernias.

Thanks

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