Biopsy of gallbladder wall with placement of cholecystostomy tube

Hi. I submitted this on the gastro forum and have had no replies. Can anyone help with this? I need an answer ASAP! Thank you in advance for all you do!

INDICATION FOR OPERATION: Patient is a ill 69-year-old white female who apparently reported for cholecystectomy on Friday of this week and instead was taken to the cath lab and coronary artery bypass grafting was eventually done on her. She continues to have nausea, vomiting, and has a rising white count and confusion. Her HIDA scan revealed no filling of her gallbladder and her ultrasound reveals a thickened gallbladder wall with no significant Murphy sign but this patient is also confused. We will take her to the operating room for evaluation and hopefully laparoscopic cholecystectomy.

DESCRIPTION OF PROCEDURE: Patient was brought to the operating room, placed supine on the operating room table. After general endotracheal anesthesia was obtained, the patient's abdomen was prepped with ChloraPrep solution and draped in a sterile fashion. Using 11 blade knife, an incision was made around the umbilicus and taken down to the fascia. Using Optiview technique, the abdomen was entered under direct vision and insufflated to 15 mmHg CO2 gas. Three additional ports were placed in the right upper quadrant. My attention was turned to identifying the gallbladder. This was rather difficult given the density of the adhesions in the right upper quadrant. This was all extremely chronic and with the patient had a dose of Plavix and this tissue was very friable in every attempt to dissect the tissue away from the very firm gallbladder that felt more like concrete lead to more ooze. I eventually was able to identify and at least expose the gallbladder. This was partly intrahepatic and a liver that was a cirrhotic appearing. This was an extremely unsafe procedure after evaluating the gallbladder and identifying the problems with bleeding, the problems with the firmness of the gallbladder, I decided to abort the procedure. Instead an incision was made in the gallbladder wall and the gallbladder fundus was opened. Bile was expressed with very little in the way of sludge. A portion of the wall there which felt very firm and mass like was excised for specimen. A small portion of liver was also excised approximately 1 x 1 x 1 cm and sent for specimen as her liver looked cirrhotic. A drain was placed into the abdomen and into the gallbladder and out through one of the port sites of the lateral abdominal wall. This was secured. The umbilical port site was closed with 0 Vicryl on a suture passing device under direct vision. The remaining ports were used to deflate the abdomen and these were removed after ensuring that the hemostasis had been achieved. The skin at all three sites were closed with 4-0 Monocryl subcuticular stitches. Glue was applied. The patient was awakened from anesthesia without difficulty and taken back to the ICU in good condition.

I am thinking 47562-52; 47534 & 47379 (liver biopsy). Would I be correct?

Need help with this ASAP please and I thank you all in advance.

Marylou Masters, CPC, COBGC

Comments

  • --part1_1f6a3f4.bdaf3ce.45c64844_boundary
    Content-Type: text/plain; charset="US-ASCII"
    Content-Transfer-Encoding: 7bit

    No, 47534 is percutaneous not laparoscopic. I would probably just go with
    the unlisted code 47579 and possibly the 47379. Quite often payers will
    not allow a gallbladder and liver procedure at the same session as the
    gallbladder actually lies in the outer layer of the liver. I would compare
    47579 to 47480-22 because of all the additional work associated with the
    firmness of the gallbladder and the cirrhotic liver.


    In a message dated 2/3/2017 9:13:26 A.M. Central Standard Time,
    marylou.masters@medigain.com writes:

    Hi. I submitted this on the gastro forum and have had no replies. Can
    anyone help with this? I need an answer ASAP! Thank you in advance for all
    you do!

    INDICATION FOR OPERATION: Patient is a ill 69-year-old white female who
    apparently reported for cholecystectomy on Friday of this week and instead
    was taken to the cath lab and coronary artery bypass grafting was eventually
    done on her. She continues to have nausea, vomiting, and has a rising
    white count and confusion. Her HIDA scan revealed no filling of her
    gallbladder and her ultrasound reveals a thickened gallbladder wall with no
    significant Murphy sign but this patient is also confused. We will take her to
    the operating room for evaluation and hopefully laparoscopic cholecystectomy.

    DESCRIPTION OF PROCEDURE: Patient was brought to the operating room,
    placed supine on the operating room table. After general endotracheal
    anesthesia was obtained, the patient's abdomen was prepped with ChloraPrep solution
    and draped in a sterile fashion. Using 11 blade knife, an incision was
    made around the umbilicus and taken down to the fascia. Using Optiview
    technique, the abdomen was entered under direct vision and insufflated to 15
    mmHg CO2 gas. Three additional ports were placed in the right upper quadrant.
    My attention was turned to identifying the gallbladder. This was rather
    difficult given the density of the adhesions in the right upper quadrant.
    This was all extremely chronic and with the patient had a dose of Plavix
    and this tissue was very friable in every attempt to dissect the tissue away
    from the very firm gallbladder that felt more like concrete lead to more
    ooze. I eventually was able to identify and at least expose the gallbladder.
    This was partly intrahepatic and a liver that was a cirrhotic appearing.
    This was an extremely unsafe procedure after evaluating the gallbladder
    and identifying the problems with bleeding, the problems with the firmness of
    the gallbladder, I decided to abort the procedure. Instead an incision
    was made in the gallbladder wall and the gallbladder fundus was opened.
    Bile was expressed with very little in the way of sludge. A portion of the
    wall there which felt very firm and mass like was excised for specimen. A
    small portion of liver was also excised approximately 1 x 1 x 1 cm and sent
    for specimen as her liver looked cirrhotic. A drain was placed into the
    abdomen and into the gallbladder and out through one of the port sites of
    the lateral abdominal wall. This was secured. The umbilical port site was
    closed with 0 Vicryl on a suture passing device under direct vision. The
    remaining ports were used to deflate the abdomen and these were removed after
    ensuring that the hemostasis had been achieved. The skin at all three
    sites were closed with 4-0 Monocryl subcuticular stitches. Glue was applied.
    The patient was awakened from anesthesia without difficulty and taken back
    to the ICU in good condition.

    I am thinking 47562-52; 47534 & 47379 (liver biopsy). Would I be correct?

    Need help with this ASAP please and I thank you all in advance.

    Marylou Masters, CPC, COBGC


    --part1_1f6a3f4.bdaf3ce.45c64844_boundary
    Content-Type: text/html; charset="US-ASCII"
    Content-Transfer-Encoding: quoted-printable






    No, 47534 is percutaneous not laparoscopic.  I would probably ju=
    st go=20
    with the unlisted code 47579 and possibly the 47379.  Quite often pay=
    ers=20
    will not allow a gallbladder and liver procedure at the same session as th=
    e=20
    gallbladder actually lies in the outer layer of the liver.  I wo=
    uld=20
    compare 47579 to 47480-22 because of all the additional work associated wi=
    th=20
    the firmness of the gallbladder and the cirrhotic liver. =20
          
     

    In a message dated 2/3/2017 9:13:26 A.M. Central Standard Time,=20
    marylou.masters@medigain.com writes:
    Hi.   I submitted this on the gastro forum and ha=
    ve had=20
    no replies.  Can anyone help with this?  I need an answer=20
    ASAP!  Thank you in advance for all you do!

    INDICATION FOR=
    =20
    OPERATION:  Patient is a ill 69-year-old white female who apparentl=
    y=20
    reported for cholecystectomy on Friday of this week and instead was take=
    n to=20
    the cath lab and coronary artery bypass grafting was eventually done on=
    =20
    her.  She continues to have nausea, vomiting, and has a rising whit=
    e=20
    count and confusion.  Her HIDA scan revealed no filling of her=20
    gallbladder and her ultrasound reveals a thickened gallbladder wall with=
    no=20
    significant Murphy sign but this patient is also confused.  We will=
    take=20
    her to the operating room for evaluation and hopefully laparoscopic=20
    cholecystectomy.

    DESCRIPTION OF PROCEDURE:  Patient was brou=
    ght to=20
    the operating room, placed supine on the operating room table.  Aft=
    er=20
    general endotracheal anesthesia was obtained, the patient's abdomen was=
    =20
    prepped with ChloraPrep solution and draped in a sterile fashion. =
    Using=20
    11 blade knife, an incision was made around the umbilicus and taken down=
    to=20
    the fascia.  Using Optiview technique, the abdomen was entered unde=
    r=20
    direct vision and insufflated to 15 mmHg CO2 gas.  Three additional=
    ports=20
    were placed in the right upper quadrant.  My attention was turned=
    to=20
    identifying the gallbladder.  This was rather difficult given the=
    density=20
    of the adhesions in the right upper quadrant.  This was all extreme=
    ly=20
    chronic and with the patient had a dose of Plavix and this tissue was ve=
    ry=20
    friable in every attempt to dissect the tissue away from the very firm=
    =20
    gallbladder that felt more like concrete lead to more ooze.  I even=
    tually=20
    was able to identify and at least expose the gallbladder.  This was=
    =20
    partly intrahepatic and a liver that was a cirrhotic appearing.  Th=
    is was=20
    an extremely unsafe procedure after evaluating the gallbladder and ident=
    ifying=20
    the problems with bleeding, the problems with the firmness of the =
    =20
    gallbladder, I decided to abort the procedure.  Instead an incision=
    was=20
    made in the gallbladder wall and the gallbladder fundus was opened.&nbsp=
    ; Bile=20
    was expressed with very little in the way of sludge.  A portion of=
    the=20
    wall there which felt very firm and mass like was excised for specimen.&=
    nbsp;=20
    A small portion of liver was also excised approximately 1 x 1 x 1 cm and=
    sent=20
    for specimen as  her liver looked cirrhotic.  A drain was plac=
    ed=20
    into the abdomen and into the gallbladder and out through one of the por=
    t=20
    sites of the lateral abdominal wall.  This was secured.  The=
    =20
    umbilical port site was closed with 0 Vicryl on a suture passing device=
    under=20
    direct vision.  The remaining ports were used to deflate the abdome=
    n and=20
    these were removed after ensuring that the hemostasis had been achieved.=
     =20
    The skin at all three sites were closed with 4-0 Monocryl subcuticular=
    =20
    stitches.  Glue was applied.  The patient was awakened from=20
    anesthesia without difficulty and taken back to the ICU in good=20
    condition. 

    I am thinking 47562-52; 47534 & 47379 (live=
    r=20
    biopsy).  Would I be correct?

    Need help with this ASAP pleas=
    e and=20
    I thank you all in advance.

    Marylou Masters, CPC,=20
    COBGC

    --part1_1f6a3f4.bdaf3ce.45c64844_boundary--
  • Jan,

    Thank you so much for your help! I truly appreciate you!

    Marylou
Sign In or Register to comment.