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07-14-2010, 5:23 PM sbwmgr Joined on 07-15-2010 Posts 1 Please help coding op note Please help coding the following op note: The patient was placed on the operating table in the supine position. After adequate general anesthesia was secured, the abdomen was prepped and draped in the usual fashion. A Foley catheter had been placed preoperatively, as well as SCD hose. The patient has had a gram of Mefoxin as well. A midline incision is made removing upper midline scar and carried out around the umbilicus. The fascia is noted to be markedly thickened. On entering the peritoneal cavity, the bowel is noted to make up a large phlegmon with edema between loops of bowel and edematous mesentery. Once pelvic adhesions tethering this mass of bowel are lysed, we then elevated this bowel mass and began with lysis of adhesion. We started at the ileum. There were numerous adhesions between loops of bowel, as well as intra loop adhesions, also adhesions involving the mesentery. We noted a single loop of jejunum adherent to the anterior abdominal wall below the umbilicus. This was a hairpin turn of small bowel and felt to be the source of her partial small bowel obstruction. We continued lysing adhesions until all adhesions were lysed from the ileum to the ligament of Treitz. We did note the jejunojejunostomy anastomosis was intact. The jejunum did pass through the transverse mesocolon to be anastomosed to the stomach. This portion of the jejunum wall was edematous, but there was no evidence of ischemia throughout close examination of her bowel. We did have two areas where the seromuscular layer had been torn. This was closed with horizontal sutures of 3-0 silk. We did not incur any inadvertent enterotomies. At the conclusion of the procedure, we copiously irrigated the abdomen with normal saline and at this point placed Seprafilm within the pelvis, then allowing small bowel contents to return to their normal anatomic position, we placed additional Seprafilm just superficial to the returned small bowel. We then pulled omentum over this and as well placed Seprafilm on either side of the abdominal cavity, as well as in the midline. Thus, we used approximately five pieces of Seprafilm and at this point two retention sutures were placed of #2 Ethilon. The fascia was then closed with running suture of #1 Prolene. These met in the middle. We tied these and then closed the skin with staples. The retentions were then tied over bridges. Dressing placed, as well as abdominal binder and the patient was transferred to the recovery room in stable. Estimated blood loss was approximately 100 to 150 cc. She tolerated the procedure well. Any advice would be very greatly appreciate.    Report

07-22-2010, 7:49 AM Mary1974 Joined on 07-16-2010 Posts 3 Re: Please help coding op note i don't know if you are coding inp or out but how about 54.59/44005?    Report

08-26-2010, 9:59 AM DevTeam Joined on 08-26-2010 Posts 3 Re: Please help coding op note The following coding could be proposed : Diagnosis bowel phlegmon -> 569.5 Abscess of intestine bowel obstruction -> 537.3 Other obstruction of duodenum jejunojejunostomy anastomosis -> V45.3 Other postprocedural states, intestinal bypass or anastomosis status Since it reads "We did note the jejunojejunostomy anastomosis was intact" the abscess was not a complication of it Procedure : 54.59 Other lysis of peritoneal adhesions Best Regards, Code-XPert - DevTeam www.code-xpert.com - ICD9-cm 2010 / 2011    Report

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