Hi,I to be not certain if these are the exactly codes and modifier because that the adhering to surgery. Should there it is in a separate code for the dcompression of ovarian cyst? would the assistant surgery append 80 come his surgery only? i did not think the main physician that is act the main PX would gain the 80. The password I have actually is 44204 and 44213 w/o 80 ( the is the major physician) thanks for your help!
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NAME that OPERATION:1 Laparoscopic-assisted sigmoid colon resection.2 Take-down that splenic flexure and also decompression the left ovarian cyst.ANESTHESIA: basic anesthesia v intubation.ESTIMATED BLOOD LOSS: approximately 100 cc.GROSS OPERATIVE FINDINGS: upon entering the abdomen v thelaparoscope, we immediately noticed some diverticulosis the the sigmoidcolon. In addition to that, there to be a huge cystic fixed consistentwith a left ovarian cyst the was strong adherent to the mid sigmoidcolon. Both digital dissection as well as sharp dissection was usedto progressively separate this framework from the sigmoid colon. The liverwas otherwise smooth with no discernible pathology. There to be noother pathology discovered in the pelvis except for the one just mentioned.DESCRIPTION of OPERATION: The patience was carried to the operatingroom, positioned top top the operating table in the lithotomy fashion.After induction the anesthesia with intubation, the abdomen to be preppedand draped in the usual sterile fashion. Marcaine 0.5% plain was nowused come infiltrate in the right upper quadrant subcostal midclavicularline and also a 5 mm harbor was inserted through this incision. Under directlaparoscopic vision, us now placed a 12 mm port with asupraumbilical incision and also a 2nd 12 mm port was now put in theright reduced quadrant in the pelvis region. Immediately, us switchedto the 30 degree 10 mm scope and, utilizing the LigaSure, we started takingdown the attachment of the sigmoid colon, relocating in a cephalad fashiontowards the spleen. We first identified the white line of Toldt andbegan remobilizing our colon, again moving to the level of the splenicflexure. We now began going down in the direction of the area that the pelvisregion. Immediately, us encountered this large complex structurewhich appeared to be cystic in nature and what appeared to it is in aarising indigenous the left ovaries. This structure likely represented avery big ovarian cyst. We figured out the cyst and also the cyst was nowdecompressed at this point in time to do dissection easier to carryout. Using the LigaSure, we started separating the structure in theleft ovary far from the sigmoid colon. As soon as we to be able come separateboth structures, we were may be to now lab retract it the end of the method andcontinue mobilizing our sigmoid colon come the level the proximal rectum.We now inserted a Gelport with a Pfannenstiel incision and also turnedthe case to laparoscopic-assisted by placing my hand and I to be able tonow ongoing mobilizing the sigmoid colon again to the level the theproximal rectum. We now concentrated in walking upwards and taking downour splenic flexure. Both digital dull dissection as well as sharpdissection with the LigaSure was used to take it the attachment of thecolon to the area the the spleen so the we can mobilize it fine andbring it every the method down to the pelvis and do an appropriateresection and also anastomosis.Once we had actually mobilized the transverse, descending and sigmoid colon tosatisfaction, we currently went come the level of the proximal rectum in ~ thelevel of the sacral promontory and we made a small hole top top themesentery the the distal sigmoid and proximal rectum area. We now useda 3.5 reticulator and also the GIA positioned throughout it, closed and also fired.We now started taking down the mesentery the blood supply making use of theLigaSure together we relocated towards the spleen. As soon as we have taken down themesentery, we were now able to lug now the whole specimen prettymuch through our Gelport at which allude we placed a bowel clamp acrossit, reduced the specimen through the mid descending colon and passed thesigmoid end the table as a specimen. We now used ours sizers andchose proper size EEA. The anvil was placed into the proximalcolon and also a reload ~ above the 3.5 Endo-GIA was now used and positionedacross the end of the colon, closed, and also fired. The anvil was broughtout proximal to our staple line. Mine assistant now went down to thearea of the pelvis. The dilated the anus and also rectum and also brought in theshaft the the 28 EEA. We positioned the on the rectal stump, opened up it,brought it along with the anvil, closed, and fired, developing ourend-to-end anastomosis. We currently tested anastomosis on the waiting whileunder saline to make certain there were no leaks. There to be no leaksidentified and also no defect, but the area to be then reinforced withseromuscular layer of 2-0 silk.At this time, the abdomen and also pelvis to be irrigated and, uponirrigation, closure was performed. Closure the the fascia defect bythe Gelport was done with a to run 1 PDS. Climate the skin scratch wasdone through 4-0 Monocryl in a subcuticular fashion.


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Port sites wereclosed additionally with 4-0 Monocryl in subcuticular fashion, complied with byBenzoin and also Steri-Strips. Patience tolerated procedure quite well.She to be then required to recovery in steady condition.