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Posted By Maria on 11-12-2018, 14:43:01 in Ob-Gyn
Hello Melanie,

This one is my first....

The same physician that delivered the pt, also performed surgery.

I don't even have a guess except for an unlisted open code.

As always, thanks for all of your help. :)


POSTOPERATIVE DIAGNOSES:


1. Same , grade one uterine invertion , with the ovaries, fallopian tubes and round ligaments inverted in the endometrial cavity

1.Stat Laparotomy with retroverting of an inverted uterus , Post Vaginal Delivery


A Pfannenstiel incision was made and carried to the underlying fascia. The fascia was incised


midline and extended bilaterally. The underlying rectus muscle was


dissected off, the peritoneum was identified and entered. At this point evaluation of the uterus showed that the bilateral ovaries , fallopian tubes were inverted in the endometrial cavity(grade one uterine inversion) , bob cocks x4 (2 on each fallopian tube ) used to grasp the round ligaments bilaterally . Huntington procedure was used to retrovert the uterus by walking the babcock along the round alignments bilaterally With gentle pull, and upward traction on the on the inverted uterine portion moves to retrovert the inverted uterine portion till a full revision of the uterine fundus , evaluation of the uterus, and bilateral adnexa, and the the round ligaments showed no laceration or bleeding


uterus was firm and no laceration in the round ligaments seen , after stabilization of the patient , and as the uterus stayed firm , uterus was placed back in the abdominal cavity ,irrigation was done with no bleeding seen , gelfoam applied for added hemostasis







Comments (1)
Posted By Melanie Witt on 11-13-2018, 14:37:24
Yikes. Okay, I would go with 59899 and use 58400 as your comparison code. This code represents a uterine suspension, and the work would be very similar to what is described above. I am assuming she was taken back to the OR for this procedure after the delivery so a modifier -78 would be reported as well.
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