Mary Beth Posted Thu 30th of April, 2020 13:33:51 PM
The provider performed an Ex Lap with gastrotomy and extraction of impacted duodenal stone. The patient has Bouveret Syndrome resulting from cholecystoduodenal fistula and impacted gallstone in the duodenum. Midline incision made, exploration of abdomen then kocherization of duodenum, gastrotomy through the pylorus able to visualize the impacted duodenal stone which was removed piecemeal. Cholecystoduodenal fistula identified, several small gallstones flushed free and evacuated. Palpation into gallbladder itself revealed a larger stone near the fundus, able to extract this as well then gallbladder flushed no further stones. Gastrotomy was closed in 2 layers. I have not been able to find a code that fits this case and feel like unlisted is my only option. Would the 43999, unlisted stomach be appropriate since he made the gastrotomy? Or should we use 44799 since the stone was removed from the duodenum? Also do you think the removal of the stone from the gallbladder fundus would be included in this unlisted? Thank you.
SuperCoder Answered Fri 01st of May, 2020 10:11:05 AM
Hi Mary Beth,
Thanks for your question.
Code 43999 (Unlisted procedure, stomach) should not be reported because incision in stomach was made to approach the duodenal stone. In fact the procedure was performed on duodenum and there is no specific code available for stone removal from duodenum. So, an unlisted code 44799 (Unlisted procedure, small intestine) should be reported.
Secondly, a large stone from gallbladder was also removed, for which, you may report code 47480 (Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure)). Please correlate this with your detailed documentation.
Since stones are removed from two different anatomical locations, you should report both the procedures separately.
Please feel free to write if you have any question.