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General Surgery Coding Alert

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Multiple Codes Cover Duodenal Ulcer Case

Question: How should we code the following case for an open gastrojejunostomy with vagotomy, pyloroplasty, and bleeding duodenal ulcer repair?
The op note follows: Identified the pylorus and followed distally, noting approximately 2 cm area of necrosis with perforation of the anterior superior duodenal wall just distal to the hepatoduodenal ligament where the bile duct and the duodenum meet. Performed a Kocher maneuver, and on manipulation, the necrotic area fell away. Opened the duodenum longitudinally through the pylorus and debrided the necrotic portion of the duodenal wall, noting a bleeding vessel at the base of the ulcer, which was oversewn with silk sutures. I performed a Heineke-Mikulicz pyloroplasty. I then opened the hiatus and removed a segment from both the anterior and posterior vagus nerves and stripped the nerves from the esophagus. I then opened the transverse mesocolon and brought up the small bowel and performed a gastrojejunostomy with [...]