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Laparoscopic resection of ureteral stricture

Bianca Posted Wed 21st of September, 2016 19:16:25 PM
Can we bill a 50544 for this procedure. Dictation reads: "Insufflation was obtained at Palmer's point, a small neck below the left costal margin, free flow of pneumoperitoneum was noted. Proceeded to then place a camera port approximately 3 cm superior to the umbilicus and lateral without difficulty, was a small amount of fat on the anterior abdominal wall; however, no evidence of significant adhesions other laterally from patient's prior procedure. Two right-sided ports were placed in addition to an assist port, 8-French below the umbilicus, with an additional left-sided port placed. Proceeded to undock the robot without difficulty. Monopolar scissor was used on the right. Fenestrated bipolar initially used on the left with a Prograsper through the third arm. Proceeded to reflect the colon along the white line of Toldt. There was some scar tissue from the patient's previous resection. However, I was able fortunately to be able to mobilize this medially to the level of the aorta from the level of the kidney down into the pelvis. There was a dense amount of scar tissue towards the bifurcation of the aorta in the area of the patient's previous repair, and hardware was able to be identified. I was able to track the ureter from the inferior pole of the kidney, noting where the ureter was drawn and medially to the area of scar as well as dissecting inferiorly below the area of scar tissue down to what appeared to be a normal ureter. It was difficult to ascertain whether or not there was an area of poor blood supply to the ureter versus the ureter simply being caught up and a reaction to the previous surgery causing circumferential narrowing. Once I was able to free up the ureter circumferentially through the area of the stricture with very careful dissection in particular over the iliac vessels, I was able to assess the ureter adequately, and I did feel that there was a distinct 1 cm area of narrowing, though once again difficult to ascertain whether or not this was a circumferential lesion just due to external compression. In any case, there was what appeared to be adequate ureter proximally and distally, and therefore I proceeded to cut the ureter at this transition point, and proceeded to resect approximately 1 cm lesion. Proceeded to spatulate proximally and distally in what appeared to be healthy, though mildly inflamed ureter. Once this was accomplished, I was able to turn my attention to reanastomosis using a 4-0 V-Loc stitch in a running fashion, starting at approximately the directly lateral aspect, sewing the back wall in a mucosal to mucosal fashion, taking full-thickness bites and proceeding to use a running stitch circumferentially. This did appear to be a watertight anastomosis. FloSeal was used due to very mild ooze in the area without wanting to devascularize ureter. I was able to wrap the ureter proximally around some fat, and the ureter was lying approximately 2 cm lateral to the previous bed of scar tissue. A Jackson-Pratt drain was placed through the third arm port, secured in place using a 2-0 nylon. At this point, the robotic instruments were removed. The robot was undocked.
SuperCoder Answered Thu 22nd of September, 2016 04:51:31 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.

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