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  • Posted by 22079, 1 year ago. There are 3 posts. The latest reply is from 22079.
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  1. Hello-
    I am wondering how exactly to code this- wondering if the partial gastrectomy should be seperately coded or just 43502. I do not see the gastroduodenostomy in the op report- unless it is assumed..
    So, in summary- should the coding be 43502, 43631, and 43235-53 ? or without the 43631 ?
    Thanks, new to General Surgery.

    PREOPERATIVE DIAGNOSES:
    Perforated stomach with upper gastrointestinal bleed.

    PROCEDURE PERFORMED:
    Exploratory laparotomy with partial gastrectomy, control of bleeding and attempted endoscopy.

    POSTOPERATIVE DIAGNOSIS:
    Perforated stomach along the greater curvature with large volumes of clotted blood within the stomach.
    2/27/2012 - 3/1/2012

    Start Time:

    Stop Time: After the diagnosis, recommended procedure and potential complications associated with the procedure were discussed with the patient's family, consent form was obtained in writing. The patient was subsequently brought to the Surgical Suite where in the supine position he had already been intubated and was administered a general anesthetic by the Department of Anesthesia. The abdomen was subsequently shaven free of hair, cleansed with chlorhexidine solution and then draped in the usual sterile operative fashion. After the okay was given by the Department of Anesthesia a large incision extending from the xiphoid process down to the umbilicus was made with #10 Bard-Parker scalpel blade. This was extended down through the dermis, subcutaneous fat through the linea alba to the preperitoneal space with Bovie cautery device. The falciform ligament was identified. A puncture was made to the left of it and the preperitoneal fat and peritoneum were transected allowing entry into the peritoneal cavity. Subsequently, it was during this period of time that a large amount of air escaped from the abdomen. A Bookwalter retractor was now assembled for retraction of body sidewalls. Subsequently, the abdomen was inspected and in the lesser omentum there was noted to be a large amount of blood stained tissue. Subsequently, I decided to bring the short gastrics down. Starting at the antrum the short gastrics were ligated with a LigaSure up to the upper portion of the fundus. I subsequently inspected the retroperitoneum and the stomach appeared to be intact with no contamination. Again the lesser omentum was identified and some blood stained fat was noted. Subsequently, the lesser omentum was bluntly opened up, as well as with the use a LigaSure. There was noted be a large rent in the lesser curvature of the stomach extending approximately 6 to 8 cm. A large amount of blood clot was extruding through this and subsequently we further squeezed the stomach to remove all blood clot from the stomach. Some active bleeding was appreciated. It was at this point that we decided to close the defect utilizing Endo stapling technique. Subsequently using a green load the lesser curvature of the stomach had been stapled and the portion of the stomach transected was submitted to the Department of Pathology. Subsequently, air was insufflated into the stomach through the orogastric tube. Water was placed in the peritoneal cavity and upon injection of the air no leak was identified. Subsequently the abdomen was thoroughly irrigated and all irrigant was aspirated free. At this point the Bookwalter retractor was disassembled. The abdominal wall was closed with running 0-PDS suture. Subcutaneous fat was irrigated with liberal amounts of saline solution and the skin edges were approximated with staples. Prior to closing the abdominal wall a Jackson-Pratt drain was brought out through a puncture site in the right upper quadrant and its position was at the lesser curvature of the stomach.

    Following the closure of the abdomen I did attempt to perform endoscopy to see if I could identify any bleeding in the stomach. I was incapable of doing this, as there was a large amount of clot in the esophagus, some blood stained oral cavity which resisted any advancement of the scope through the upper esophageal sphincter.

    The patient had tolerated this procedure without difficulty. He was returned to the Recovery Room in stable condition.

    Findings at time of surgery are consistent with that of a large rent in the lesser curvature of the stomach, as well as large amounts blood clot within the lumen of the stomach.

  2. I did not see here partial gastrectomy. In partial gastrectomy, distal stomach (antrum) should be dissected from the surrounding structures and blood supply to the antrum should be divided, later antrum should be removed. Here OP report says “Starting at the antrum the short gastrics were ligated with a LigaSure up to the upper portion of the fundus and portion of the stomach transected and submitted to pathology.” Additionally there is no anastomosis of stomach and duodenum (gastroduodenostomy). So as per this OP note, you should report below two codes:
    43502
    43235-53
    ********
    Still if you would consider by this short notes as a partial gastrectomy and would like to code for the same by appending reduced services modifier (52) to 43631 (as gastroduodenostomy not done here), again attempted endoscopy (separate procedure) should be billed with -59 modifier and -53 for discontinued services. Better you should code only two codes and should not code partial gastrectomy here.

  3. thanks so much- i did not see the partial gastrectomy either ...

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