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  • Posted by 35957, 1 year ago. There are 2 posts. The latest reply is from SuperCoder.
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  1. Hi- can someone please help. I have physician billing for resection large abdominal mass and am wondering what CPT codes physician may bill for, or are certain procedures included. The following codes were billed for this patient:
    "49205, 15734, 43610, 47600, 48100, 76998-26"
    Here are the procedures which were performed.
    PROCEDURE:
    1. Resection of large intra-abdominal mass associated with the stomach, small bowel, colon and pancreas.
    2. Myofascial abdominal wall flap (falciform pedicle flap).
    3. Partial gastrectomy with primary repair.
    4. Cholecystectomy.
    5. Excision of a portion of the pancreatic mass (tail of pancreas) .
    6. Total omentectomy.
    7. Intraoperative ultrasound of the liver

    FINDINGS: At the time surgery included a large inflammatory mass that was occupying the majority of the left upper quadrant. This mass was excised in total and after several biopsy was found to be nonmalignant in nature. Of note, there was no evidence of carcinomatosis. Intraoperative ultrasound of liver revealed normal hepatic anatomy. These images were stored in the patient's chart. The pancreas itself was firm and whitish in appearance and a biopsy of the tail of the pancreas later returned negative for carcinoma.

    TECHNIQUE: The patient was placed supine on the operating room table and after the induction of general anesthesia, the entire abdomen was prepped and draped in the usual sterile fashion. Midline incision was made with 10-blade scalpel with Bovie cautery used to dissect down through to the level of the abdomen. Upon entering the abdomen, the left upper quadrant mass was easily identified. This appeared to be involving the abdominal wall and a portion of the peritoneum was taken en bloc with the mass and EnSeal device was used to
    mobilize the omentum. The omentum was taken off completely and sent to
    pathology labeled total omentectomy. The mass itself was involving a portion of the stomach and upon excising the mass, a portion of the stomach was excised with the mass. The stomach was later repaired with interrupted 3-0 silk sutures. The mass was also involving the mesentery of the transverse colon. Care was taken to preserve the mesenteric vessels as the mass was removed from the mesentery of the colon within the lesser sac.
    Several biopsies of the mass later returned negative for carcinoma and
    consistent only with inflammatory cells. The pancreas was inspected. There was a masslike structure in the tail, however, this was felt to likely be inflammatory. Biopsy was taken of this mass. This later returned negative for carcinoma as well. The abdomen was irrigated. Bovie cautery was used to obtain adequate hemostasis.
    Given the findings of a question of chronic pancreatitis, the gallbladder was removed as a possible source of the pancreatitis. The gallbladder was removed in a retrograde fashion. Bovie cautery used to dissect down through to the level of the gallbladder bed. Surgiclip was used to ligate the cystic duct and cystic artery. The flaps raised off the anterior abdominal wall. This myofascial abdominal wall flap was raised to preserve the blood supply as it
    emanated from the liver. This flap was then placed through the hepatogastric ligament and was placed over the area of the previous excision and repair of the stomach and this was sewn in place with 3-0 silk suture. Intraoperative ultrasound of liver revealed normal hepatic anatomy. These images were stored in the patient's chart.
    Attention was then drawn towards closure of the abdomen.

  2. I agree with the set of codes. There is no bundling between any of the codes. There is little confusion over 43610 as a portion of the stomach was also excised with the mass.There is no code for simple partial gastrectomy,hence 43610 seems correct here.

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