query needed? query choices... for peritoneal lysis of adhesions
Hello,
Admittedly not surgical coding expert.
A query was issued to ask the surgeon what part of the bowel were the lysis of adhesions performed. He felt it was a crazy question. Below is an excerpt that I hope is sufficient.
Two questions-
1. was a query needed at all? Or would this provide enough to code lysis of adhesion of peritoneum ( the peritoneum and word lysis are not stated in the same sentence BUT is the bowel being adhered to the wall good enough; or
2. If a query was needed, any issue with including peritoneum in the choices, in addition to bowel locations?
Thank you,
Ann
“This adhesional lysis required a considerable amount of time utilizing blunt sharp and electrocautery dissection to safely dissect free the layers of bowel that were adherent from the anterior abdominal wall and from other loops of bowel.”
The midline peritoneum was closed and a 10 x 12 inch Marlex mesh was placed into the preperitoneal/ retrorectus space and the fascia was closed over this with multiple drains being placed. Due to the extensive adhesions that were present within the abdominal cavity, and extensive adhesional lysis was required. This adhesional lysis required a considerable amount of time utilizing blunt sharp and electrocautery dissection to safely dissect free the layers of bowel that were adherent from the anterior abdominal wall and from other loops of bowel. This extra time was required to perform a safe and adequate procedure.
If too much of an inference, would these choices be appropriate:
Peritoneal adhesions to bowel
Large
intestine (if known,please further specify portion of large intestine)
Small intestine (if known,please further specify portion of small intestine)
Other (please specify)
Clinically Unable to Determine
Not Applicable
thank you!
Ann
Comments
I would recommend a query asking the doctor to identify the specific anatomical sites "released". There are multiple code possibilities and he needs to be specific. Using a list of choices is one possibility and the peritoneum could certainly be one of the choices along with intestine, ileum, etc.
For education sake maybe visiting with the doctor with a screenshot of the encoder page showing all the choices we have to pick from would help him understand why specifics are needed.
Erik
Thank you!
The lysis of 'intestinal adhesions' aka Ladd's bands (Q43.3, Congenital malformations of intestinal fixation) is a very different condition. The bands are may be single or only a few and usually presents as intestinal obstruction. In that case, specificity as to the involved bowel is necessary.
In the case presented, the peritoneal adhesions were diffuse (and likely related to prior surgery or previous peritoneal inflammation) and not c/w Ladd's bands. A query in this circumstance would not be necessary.