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Gastrografin exam of Enteric Cutaneous Fistula Tract and Ileostomy

Eleen Posted Thu 30th of August, 2012 13:57:00 PM

What would the correct cpt codes be for the following exams? I was thinking 20501/76080 for the enterocutaneous fistula tract and 49465 for the Ileostomy.

EXAM: GASTROGRAFIN EXAM OF ENTERIC CUTANEOUS FISTULA TRACT AND ILEOSTOMY.

COMPARISON: CT OF THE ABDOMEN AND PELVIS 02/29/12

DATE: 07/27/12

INDICATION: MULTIPLE ABD SURGERIES AND BOWEL RESECTIONS, NOW WITH LONG-STANDING ECF

PROCEDURE: FOLEY CATHETER WAS INSERTED INTO ILEOSTOMY, GASTROGRAFIN WAS ADMINISTERED AND WAS ALLOWED TO FILL THE BOWEL LUMEN. A FOLEY CATHETER WAS ALSO PLACED SITE OF SUSPECTED ENTEROCUTANEOUS FISTULA AND GASTROGRAFIN WAS ADMINISTERED. FLUOROSCOPIC TIME 2.0 MINUTES.

FINDINGS:
ON THE SCOUT IMAGE, THE BOWEL GAS PATTERN IS NONOBSTRUCTIVE. THERE ARE NO ABNORMAL CALCIFICATIONS PROJECTED IN THE REGION OF THE KIDNEYS, BLADDER, OR GALLBLADDER. OSTOMY SITE IS SEEN PROJECTING IN THE RIGHT LOWER QUADRANT. WOUND BAG IS SEEN MIDLINE OVER THE ABDOMEN.

FOLLOWING THE ADMINISTRATION OF GASTROGRAFIN INTO THE OSTOMY SITE CONTRAST IS SEEN TRAVELING THROUGH SECTION OF SMALL BOWEL AND THEN EXITING AT THE ENTEROCUTANEOUS FISTULA SITE WITH CONTRAST MATERIAL THEN EXITING INTO THE WOUND BAG. FOLEY CATHETER WAS PLACED INTO THE ENTEROCUTANEOUS FISTULA AND CONTRAST WAS SEEN TRAVELING THROUGH SECTION OF SMALL BOWEL AND COMING OUT OF THE OSTOMY SITE. MULTIPLE ATTEMPTS TO RETROGRADELY CANNULATE OTHER BOWEL LUMENS WERE UNSUCCESSFUL.

IMPRESSION:

ILEOSTOMY TRACT CONNECTING TO ENTEROCUTANEOUS FISTULA. PROXIMAL BOWEL COMMUNICATIONS TO ENTEROCUTANEOUS FISTULA COULD NOT BE DETERMINED, AS PORTIONS OF THE FISTULA ARE COVERED BY THE OSTOMY BAG. PATIENT DECLINED BARIUM ENEMA.

SuperCoder Answered Tue 04th of September, 2012 20:41:33 PM

Hi Eleen,

We are working on this. Will get back to you soon.

Thanks

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