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Posted By Mary Peabody on 03-17-2020, 12:07:28 in Ob-Gyn
Hello Melanie,

Would you code this procedure with an unlisted laparoscopy procedure, intestine, CPT 44238?
1. Diagnostic laparoscopy
2. Robotic assisted resection of sigmoid colon mesenteric mass
3. Peritoneal washings
A 5mm skin incision was made 2-3cm below the costal margin in the mid-clavicular line. An optiview trocar with the 5mm laparoscope was introduced into the abdomen under direct visualization. Peritoneal entry was confirmed visually and the the peritoneal cavity was then insufflated with C02 gas. The patient was placed in steep trandelenberg. A survey of the abdomen and pelvis was then performed with the above findings. There was no injury to visceral structures with laparoscopic entry.
The remainder of the robotic and laparoscopic ports were then placed under direct visualization in a semilunar shape in the patient's upper abdomen. The robot was then docked to the left of the patient and the robotic arms secured to the ports. The robotic camera was introduced through the supraumbilical port and secured to the robotic arms. The bipolar, monopolar and Cartier instruments were introduced under direct visualization through the robotic ports. Washings were performed. With minimal manipulation of the mesenteric mass the cyst wall ruptured clear fluid which was included in the peritoneal cytology. I then un-scrubbed and sat at the robotic console.
The sigmoid colon was gently retracted towards the anterior abdominal wall to expose the cyst. The cyst capsule was adherent to the peritoneal layer of the sigmoid. Using minimal cautery the peritoneum was incised and the cyst was dissected out of the mesentery. The cyst base was adherent to the peritoneum overlying the common iliac vessels but easily separated along an avascular plane from these vascular structures beneath. Working circumferentially, the cyst was dissected away from the peritoneum and mesentery and then released from these tissues. The cyst was then placed into an endocatch bag, removed from the peritoneal cavity and sent to pathology for evaluation.
Comments (1)
Posted By Melanie Witt on 03-18-2020, 19:07:14
Yes, and you will have to report 44238 for this. You maybe could compare the work to 49203.
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