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Georgia Posted Wed 05th of June, 2019 15:59:56 PM
Two doctors with same speciality would like to bill separately. They started by doing pubovaginal sling by Doctor 1. We put a 16French foley catch in and used the balloon to verify the level of bladder neck, did a midline abdominal incision dividing the vaginal mucosa, then dissected the vaginal mucosa from the underlying periurethral tissue. The tissues are very soft and friable that we were able to dissect and dissection was carried all the way to the retro public space on both sides. We made a small incision in the cervical area on either side of the midline of Supra public region. With a special needle passer, we passed the needle first on the lt then rt side. At this point we removed the catheter and did a cystoscopy which shows normal urethra, bladder and no inadvertent injury to bladder wall passing the needles and then both Ureteral orifices were seen with clear efflux. Scope removed and foley place again. We placed mesh made by BSL exact on mid urethra without any tension. The excessive mesh was removed. The vaginal wall was closed in two layers using 3-0 Vicryl. Then doc #2 went ahead for abdominal colposacropexy as Pt has multiple abdominal surgeries before we had a very hard time, but were able to place all the ports. We placed the 1 port supraumbilical, one below umbilicus, then fingerbreadths lateral to this and final 5th port. We had some adhesions and had to dock robot. I went ahead and dissected all extensive adhesions which was attached the bowel to the abdominal wall and after taking down all adhesions, we identified the sacrum, posterior peritoneum and the ureter, we identified the rt. ureter dissected literally, opened posterior Peritoneum on the promontory of the sacrum and clear up the anterior sacral ligament and we can see it very well. Then I placed the special retractor in the vagina which allowed us to push on the vaginal vault upwards and then dissected the bladder anteriorly from the anterior vaginal wall and the rectum posteriorly from the posterior vaginal wall. She has a very redundant rectum and sigmoid colon, probably due to chronic constipation , but we were able to retract this laterally and got the whole top exposed. We used y mesh. We fashioned it and then secured the anterior flap of the mesh to the anterior vaginal wall using multiple 2-0 Prolene and then the posterior flaps to the posterior Peritoneum and secured it to the anterior sacral ligament using two 2-0 Prolene sutures incorporating the anterior sacral ligament. Excessive mesh was removed. Posterior Peritoneum was closed. Abdomen was inspected for any bleeding and after taking down pressure there was no extensive bleeding or evidence of bleeding. Then we removed all ports and closed the skin. The the doctors were thinking they could billed as co-surgeons because one does robotic procedure and the other doctor does not. Or Can doctor #1 bill for Pubovaginal sling 57288 and Dr.#2 bill for Colposacropexy 57425? As separate Billings? I assume the Lysis of adhesions and dissection of rut ureter is included in above? Thank you for your help and any suggestions
SuperCoder Answered Thu 06th of June, 2019 08:27:53 AM

Hi Georgia,

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

SuperCoder offers SuperCoding on Demand (SOD) ( for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail for more information.

Thank you.

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