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Posted By ob/gyn on 03-21-2018, 10:58:19 in Ob-Gyn
Is the Implants graft/packing placed in the vaginal for hemostasis bundled into the H-D&C?

Thanks for any help/guidaince!



DATE OF SERVICE: 02/10/2018

Preoperative Diagnosis: Retained products of conception.

Postoperative Diagnoses:
1. Clots versus retained products of conception.
2. Vulvar yeast infection.
3. Cervical laceration.

Procedure: Diagnostic hysteroscopy, dilation and curettage, implants
grafts/packing placed in the vagina for hemostasis.

Anesthesia: General anesthesia via LMA and 2% lidocaine with
epinephrine.

Findings: Erythematous vulva. The cervix was dilated approximately 5
mm,
hysteroscopy with a MyoSure hysteroscope was easily inserted into the
uterine cavity not requiring dilation. The endometrial cavity was
shaggy,
both fallopian tube orifices visualized and unremarkable. On the
posterior
wall of the uterus there was clot versus tissue arising just above the
lower uterine segment. There were free sutures protruding into the
endometrial cavity anteriorly consistent with a cesarean section scar.
The
cervix was quite friable. There was evidence of a prior suture
anteriorly
at 12 o'clock. It is of note that the uterus became quite atonic with
introduction of the hysteroscope and Pitocin was administered through her
IV fluids.

Complications: Friable tissue of the cervix.

Estimated Blood Loss: 75 cc.

Pathology Specimens: Endometrial curettings.

Condition: Stable. Foley placed because of placing vaginal packing.

Description of Operation: The patient was brought into the operating
room,
placed supine on the operating room table where general anesthesia via
LMA
was administered in the usual fashion. She was then placed in the dorsal
lithotomy position, prepped and draped in the usual fashion for vaginal
surgery. A Sims retractor was placed posteriorly and an anterior Heaney
retractor. The cervix was identified. There was a suture at 12 o'clock.
I gently in the vertical direction applied a single-tooth tenaculum. The
5
mm 0 degree MyoSure hysteroscope was inserted into the uterine cavity
using
an Aquilex fluid management system. Hysteroscopic examination revealed
the
above-noted findings. I attempted to irrigate out clots. I then
introduced the MyoSure Lite device to remove additional clots. I removed
the MyoSure device and MyoSure hysteroscope and gently curetted the
posterior wall of the uterus for additional friable round red tissue.
There was considerable oozing of the cervix and the uterus became quite
boggy. Pitocin was administered through her IV fluids during this
portion
of the procedure. Given the patient's past history, I elected to place
vaginal packing and a Foley because of the vaginal packing. The patient
was then reversed from anesthesia and transferred to the recovery room.
Comments (1)
Posted By Melanie Witt on 03-21-2018, 16:46:30
Yes, hemostasis is included in all surgical procedures and this one would be no exception in my opinion. And although the CPT code for vaginal packing, 57180, is not bundled under CCI if you try and bill this code do not be surprised if you get a denial.
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