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Posted By Maria on 08-27-2019, 12:16:03 in Ob-Gyn
Hi Melanie,

Hope I catch you before you leave tomorrow!
Such a nice vacation!

Dr coded this as 58200
Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s)

1. Would you please point out the vaginectomy work to me?

I see he cut the cervix/uterus from the underlying vagina.

Path: A.  Uterus, cervix, bilateral fallopian tubes and ovaries, hysterectomy
with bilateral salpingo-oophorectomy:
       Cervix with fibrohistiocytic reaction from previous surgery site,
cervicitis and focal (2mm) residual infiltrating squamous cell carcinoma
(status post radiation).
       Inactive endometrium.
       Bilateral ovaries with no pathologic changes.
       Bilateral fallopian tubes with no pathologic changes.

B.  Right pelvic lymph node, excision:
       Three lymph nodes (0/3), negative for metastasis.

OP Note

Uterus and cervix stuck to sigmoid colon. Dense adherence of left pelvic sidewall. Mild enlarged nodes in right pelvic area. Normal upper abdomen.
Uterus, cervix, bilateral fallopian tubes and ovaries, right pelvic lymph nodes
After assuring informed consent the patient was taken back to the operating suite and induction of general anesthesia was done. The patient was placed in the modified dorsal lithotomy position in Allen stirrups then prepped and draped in the normal sterile fashion.
A midline vertical skin incision was made from the symphysis pubis to up around the umbilicus. The incision was carried down to the fascia with the bovie cautery. The fascia was then incised and the incision was extended superiorly and inferiorly. The rectus muscles were separated in the midline. The peritoneum was identified and entered sharply, then carried superiorly and inferiorly with good visualization of the bladder.
The bowel was then packed back and attention was taken to the pelvis. The round ligaments were then cauterized bilaterally and the retroperitoneum was then entered. The pararectal and paravesical spaces were opened and the ureters were identified bilaterally. The infundibulopelvic ligaments were clamped with zeppelin clamps x 2, cut and tied off with a 0-vicyl free tie and then a 0-vicryl single stitch fashion. The broad ligament was taken down bilaterally to the uterus and the uterine arteries were skeletonized bilaterally. The bladder flap was created with the bovie and pushed down past the cervical-vaginal junction. The uterine arteries were clamped with curved zeppelin clamps, cut and tied off with a 0 vicryl in single stitch fashion. The cardinal ligaments and uterosacral ligaments were then clamped with straight zeppelin clamps, cut and tied off with 0-vicyl in Heaney stitch fashion. Right angle zeppelin clamps were then used to clamp across the cervical-vaginal junction and Jorgenson scissors were used to cut the cervix/uterus from the underlying vagina. 0-vicryl was used to close the vaginal cuff in Heaney stitch fashion bilaterally. Figure of eight stitches of 0-vicrly were then placed in the vaginal cuff for good hemostasis.
The right external iliac lymph nodes were then removed with the margins of resection being the genitofemoral nerve laterally, the ureter medially, midportion common iliac artery superiorly and distal circumflex iliac vein inferiorly. The left side was not removed due to dense adherence of the tissue against the iliacs. The case was turned over to XXX for colon resection and reanastamosis.

Comments (1)
Posted By Melanie Witt on 09-18-2019, 18:10:29
There is no description of this. The vignette for this code includes the following: The upper portion of the vagina is removed. The specimen is sent for frozen section.
You need to point this out to the surgeon and ask him or her do an addendum or otherwise you cannot bill 58200 with a modifier -52.
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