Lynn Posted Mon 22nd of August, 2016 06:59:15 AM
Procedure: EXPLORATORY LAPAROTOMY, extracorporeal drainage of large pelvic mass, extensive lysis of adhesion, left salpingo-oophorectomy, repair of sigmoid colon serosa, pelvic mass removal, appendectomy, omental biopsy and pelvic washings.
The mass was then drained extracorporeally, using Tegaderm and Dermabond combination. Approximately 5900 cc of fluid was drained. The incision of the drainage was sutured using 0 Vicryl to prevent further spillage of fluid into the abdominal cavity. The incision was then enlarged to exteriorize the mass. At this point, the large bowel, sigmoid colon was densely adherent to the mass. Extensive lysis of adhesion was needed. We noted serosal tear on approximately 3 cm area of the sigmoid colon, these were repaired with interrupted 3-0 silk stitches. Mesentery was not affected.
Once the mass was free of the bowel, the left ureter was identified and the infundibulopelvic ligament was doubly clamped, cut and suture tied. The mass was then sent for frozen section which revealed likely mucinous cystadenoma(benign).
The appendix was tented up using Babcock clamp. Meso-appendix was clamped using 2 tonsils, cut and suture tied. The appendix at its base was then clamped using to Kocher clamps. The appendix was dissected between the clamps and passed off for permanent. The pedicle of the appendix was secured using 3-0 silk, followed by a pursestring suture to bury the pedicle. DX benign neoplasm of ovary Not sure what codes to use for this. Please help.
SuperCoder Answered Tue 23rd of August, 2016 04:15:06 AM
The CPT codes that may be billed for the above procedures performed are:
CPT 44955 for appendectomy as the Dx was for some other procedure.
CPT 49203 till 49205 depending upon the mass size.
CPT 49180 for Bx.
Rest of the minor procedures performed unbundles to major procedure. Thank you.