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laparoscopic repair of perforated pouch ulcer, placement of a gastrostomy tube

Susan Posted Mon 04th of May, 2020 20:14:04 PM
Pt abdomen was then prepped and draped in normal sterile fashion. A 12mmOptiview trocar was then used to access the abdomen above the umbilicus. Next, additional trocars were placed on the right side due to extensive omental adhesions noted on the midline and just at the left of the midline. Once these trocars were placed in the right, where i was able to take down the omental adhesions and visualized the Roux limb. There was copious amounts of succus intra-abdominally over the right lobe of the liver, which was suctioned free from the abdomen. we freed up sing the harmonic scalpel. Multiple adhesion along the left lobe of the liver, allowing access finally to a large perforated pouch ulcer though the enteroenterostomy. This was freed up again with blunt and sharp dissection. At this point, we used 3-0 Vicryl to close the perforation, this was done with two layer of running 3-0 Vicryl. An 18-French G-tube was brought through the left upper quadrant and passed through the gastrostomy where i placed a 2-0 Vicryl pursestring stitch in the antrum. The balloon was inflated and the 2-0 Vicryl was tied in thightly around the tube. Hemostasis appeared to be adequat at this point, G-tube and drains were secured in position with 2-0 nylon. Dressing applied and the procedure was complete. is this coded with 43659 proc only?
SuperCoder Answered Tue 05th of May, 2020 08:42:31 AM

Hi Susan,


Thanks for your question.


There is no CPT code for laparoscopic repair of perforated pouch ulcer with placement of a gastrostomy tube. So, the code suggested by you is absolutely correct i.e. code 43659.


Please feel free to write if you have any question.

Susan Posted Tue 05th of May, 2020 10:37:11 AM
Would there be a second code it can be compared to for pricing purposes?
SuperCoder Answered Wed 06th of May, 2020 09:35:05 AM

Code 43653 - Laparoscopy, surgical; gastrostomy, without construction of gastric tube (eg, Stamm procedure) (separate procedure) can be used as a comparison code for unlisted code 43659 (Unlisted laparoscopy procedure, stomach) for pricing purposes.


Hope this helps.



Susan Posted Wed 06th of May, 2020 11:21:26 AM
Thank you very much. For this procedure if a Blake drainage was placed as well. Would it need to be coded separately?
Susan Posted Wed 06th of May, 2020 17:31:49 PM
"At this point, this could get additional copious irrigation was performed and Blake drains were placed one in the left upper quadrant and one across the anastomosis" Would this need to be coded as well, and if yes, what would be the appropriate code?
SuperCoder Answered Thu 07th of May, 2020 05:40:18 AM

Abdominal surgeries usually require the placement of drains postoperatively, which are included in the main procedure and hence should not be reported separately.


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