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Posted By Sandy B on 01-28-2020, 16:32:34 in Ob-Gyn
Looking for codes for laparotomy with removal of foreign body and repair of vaginal cuff dehiscence.
I found 49402 (removal of foreign body from peritoneal cavity) for the laparotomy with removal of foreign body but I am having a difficult time finding a code for the vaginal cuff repair.

Thanks
Comments (2)
Posted By Sandy B on 01-31-2020, 15:08:52
Here is the operative report! Any help would be great! Thanks!

Pre-op diagnosis:
1- vaginal cuff dehiscence
2- foreign body in abdomen, probable bowel prolapse through the vaginal cuff

Post-op diagnosis:
1- vaginal cuff dehiscence
2- foreign body in abdominal cavity

Procedure:
Exploratory laparotomy with removal of foreign body and repair of vaginal cuff dehiscence

Description of procedure:
After receiving IV antibiotics and general anesthesia, the vagina had been prepped, a Foley catheter placed in the bladder. Bimanual exam revealed a hole in the vaginal cuff appx 5cm long. The pessary could be palpated through this. No bowel prolapsing through the dehiscence was appreciated. Gloves were changed and the abdomen was opened in the pfannenstiel manner through old laparotomy scar. Upon opening the abdomen, the bowel was pulled out of the pelvis and the pessary was identified and removed. The bowel was packed from the operative site and the pelvis was exposed. There was a 5-6cm opening in the top of the vagina. The edges of the vagina appeared healed. There were no fresh tears, consistent with poor healing after the primary surgery. The cuff was identified and elevated, and the vaginal mucosa was cut open for fresh tissue circumferentially. The vaginal cuff was then closed all around with interrupted figure-of-eight stitches of 0 vicryl suture. There was an adhesion from the small bowel to the left adnexal region and this was identified and taken down sharply. There was also a brownish cystic mass or nodule, appx 1 cm, attached in this region. The etiology was uncertain. It was excised and also being sent to pathology. The pelvis was copiously irrigated with normal saline solution and inspected. The bowel appeared normal. There was good hemostasis at all areas. All instruments and sponges were removed. The bowel replaced in the pelvis. Rectus muscle and peritoneum reapproximated with running 2-0 vicryl. The anterior rectus fascia and muscle were inspected. The anterior rectus fascia was closed with running @1 vicryl. Subcu space inspected, reapproximated with running 3-0 vicryl and the skin closed with running subcuticular 3-0 monocryl. The patient was then awakened and taken to the recovery room in satisfactory condition.
Posted By Melanie Witt on 01-31-2020, 13:52:15
I would want to the op note for this surgery in order to give you an accurate answer.
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