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Dasika Posted Fri 25th of March, 2016 10:16:56 AM

What CPT code should be used for correct coding for a combined approach of endoscopic closure of gastro cutaneous fistula with EGD and Clips by the first physician and at the same time, a surgical approach by the second physician with abdominal wound debridement and closure externally

INDICATION/HISTORY: Patient was admitted over this past weekend
with a gastrocutaneous fistula resulting from a percutaneous
endoscopic gastrostomy tube that was placed over a year ago in
preparation for combined modality therapy for head and neck
cancer. The tube became dislodged 2 weeks ago at which time he
presented to the Emergency Department with bleeding from the
edges of the gastrostomy site. This required a suture ligation
in the ER. Thereafter he was sent home with dressing changes
but the gastrostomy failed to close resulting in essentially a
gastrocutaneous fistula. He was admitted for this and has been
receiving wound care and nutritional repletion with TPN since
that time. The plan today was to use a combined approach with
Dr. Huffman (Gastroenterology) performing endoscopic closure
with EGD and clips and at the same time, a surgical approach by
me with wound debridement and closure externally.

PROCEDURE: The patient was taken to the Operating Room and
placed in the supine position. After induction of general
endotracheal anesthesia, the abdomen was prepped and draped
around the fistula site. It should be noted that Dr. Huffman
was doing his part of the procedure concurrently with mine.
Please see his note for details in that regard. Multiple full-
thickness mucosal sutures were placed in a transverse
orientation closing the gastrocutaneous fistula. This was done
with 3-0 Vicryl. Full-thickness bites were visualized
endoscopically. This provided an airtight closure for Dr.
Huffman to insufflate the stomach. He then performed clipping
of the mucosa from the inside of the stomach. Please see his
note for details. A debridement of the necrotic skin and fatty
tissues around the region was performed externally with cautery
and a curette. Cautery was used to obtain excellent hemostasis.
The fascia around the fistula was debrided back to healthy
tissue. The fascial defect was then closed without much tension
using multiple interrupted 0 Vicryl sutures in a transverse
fashion. Prior to this, Tisseel fibrin sealant was placed
directly over the mucosal closure. The fascial closure was over
this. The wound was then dressed with saline-soaked Kerlix
gauze and a sterile compressive dressing placed over this. The
patient tolerated all this well. He was taken back to the
Recovery Room in stable condition after extubation.

North Carolina subsciber

SuperCoder Answered Sun 27th of March, 2016 23:45:20 PM


AAE does not provide coding for operative reports and chart notes. SuperCoder offers SuperCoding on Demand (SOD) ( for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail for more information.

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