Lap APR/exc ileoanal reservoir/ileostomy

I am posting the op report for this one. The surgeon is wanting to bill 45395 for Lap APR and 45136, which would have to be unlisted since done lap. I am thinking the 45395 is included.

PROCEDURE: 1. Laparoscopic abdominoperineal resection with ileoanal pouch anastomosis removal. 2. End ileostomy. NARRATIVE: The patient was brought back to the operating room and placed supine position. General endotracheal anesthesia performed. The patient was then placed in supine position. The abdomen was prepped and draped in the usual sterile fashion. Should note the patient did receive preop antibiotics, SCDs, Foley catheter and oral gastric tube. A timeout was performed identifying the patient and the procedure to be performed. I made an incision around the ileostomy and dissected down to the abdomen. I used the stapler to come across in between the 2 limbs of the ileostomy. I dropped this back down in the abdomen. I then went in laparoscopic after placing 2 other ports. The J-pouch was in good condition and laying appropriately. I then freed up the J-pouch came across the mesentery with the LigaSure device. I then circumferentially freed up the J-pouch all the way down to the pelvic floor. There was a small fluid collection on the right aspect of the J-pouch which was irrigated copiously. I then brought up the ileum up to the ileostomy site. I laparoscopically make sure that laid well. I then placed a drain down into the pelvis. This ileostomy was matured in usual Brooke fashion. At this point Dr. B performed the perineal dissection removing the rectum, anus and perianal skin. This was a difficult dissection as there was a lot of fibrosis. The J-pouch was also removed through the perineal wound. After this area was copiously irrigated. The levators and any remaining musculature was closed serially. The skin was reapproximated also. The patient tolerated the procedure well. Lap and instrument count were correct x2. The patient was brought to recovery in stable condition.

Comments

  • When validating the lap APR 45395 with lap ileostomy 44186 the codes do not edit in CCI. Additional  validating the open procedure 45110 protectecomy complete & 45136 excision of ileoanal res the codes do not edit. CCI is not including these two procedures as components.  laparoscopic procedures. 45395 includes colostomy, I didn't see creation of colostomy documented in the operative report.
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