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Laparoscopic-assisted mid rectal transection and formation of an end colostomy

E. maria Posted Thu 03rd of March, 2011 06:54:38 AM

Need help with CPT code, can anybody help? Here is the op note:

Postoperative diagnosis: Chronic anal incontinence

Procedure: Mid rectal transsection and formation of an en colostomy, laparoscopic-assisted.

Findings and description of procedure:

Following satisfactory general endotracheal anesthesia, the patient was prepped and draped in the sterile manner. Veress needle was placed at the umbilicus and C02 insufflation was obtained. Four separate 5 mm trocars were placed and dissection was undertaken, separating the sigmoid colon from its lateral attachments and then dividing the sigmoid colon from its lateral attachments and then dividing the peritoneal attachments on the left side down into the pelvis but then having considerable problem with the redundant sigmoid in achieving adequate exposure to dissect well down into the upper rectum which with the intention in an effort to minimize the mucus discharge that has been troubling her so much. Difficulties also in achieving mobilization of the small bowel out of the pelvis led to proceeding with an open portion of the surgery at that point. A limited lower midline incision was made and extended into the abdominal cavity. Appropriate retraction was achieved lifting the uterus up and away from the upper rectum and then packing the small bowel out of the field. The redundant sigmoid colon was then further released and mobilized so it could be pulled up out of the abdomen and allow better exposure of the distal sigmoid. Then, ultrasonic scalpel was utilized to divide the peritoneal attachments on both sides of the lower sigmid and then develop the presacral plane down to the coccyx. The lateral stalks of th upper rectum were divided using ultrasonic scalpel and then a defect was made in the mesentery to allow passage of the contour stapling device. This was ensured to be in good position and not including any of the vagina and was fired. The remaining mesenteric attachments to the distal segment were divided with the ultrasonic device and then the upper rectum and lower sigmid were mobilized up to the planned colostomy site. The redundant sigmoid was allowed to fall in the pelvis. It was elected not to resent a section of colon as she was happy with her bowel habits in general and has a tendency toward intermittent problems with diarrhea. This redundant sigmoid colon did not appear to have any significant disease disorder by external inspection. Colostomy site was prepared going through the rectus abdominis muscle in the usual manner oriented at a previously marked colostomy site in the left lower quadrant. Adequate colon was brought through this defect and then this was sutered at the peritoneal aspect with 3-0 Vicryl. Irrigation was performed and the midline wound was infiltrated thoroughly with a quarter percent Marcaine with epinephrine and then the fascia was closed with a double-stranded #1 PDS. Skin was closed with clips. Colostomy was then matured using interrupted 3-0 Vicryl. Patient was awakened and taken to recovery in stable condition without evidence of ummediate complication.

Nikhil Answered Fri 04th of March, 2011 09:19:37 AM

Seems no exact code although very close to 44206, but different in many other ways. So, Unlisted cpt 44238 would be possible option.

E. maria Posted Mon 07th of March, 2011 05:19:49 AM

Thank you for your help

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