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laparotomy, liver biopy, gastrojejunostomy

Laura Posted Wed 08th of August, 2012 12:10:26 PM

Our 55 year old patient had an exploratory laparotomy, liver biopsy and gastrojejunostomy with placement of gastrostomy and jejunostomy tube, cholecystojejunostomy.

A midline incision was performed and carried through skin and subcutaneous tissue. The peritoneal cavity was entered. Upon entering the abdomen, he was found to have multiple small liver mestateses involving both lobes of the liver. a small wedge biopsy of the liver was performed to encompass a nodule that was located at the very surface of the left lateral segment of the liver. Cautery was used for hemostatsis. He had a mass on the pancreas, swollen gallbladder. I decided to bypass his stomach with the gastrojejunostomy, and bring up a loop of small bowel in order to perform CHOLECYSTOJEJUNOSTOMY, SINCE HIS COMMON BILE DUCT WAS NOT ENLARGED. INSTEAD OF PASSING A SINGLE TUBE, THE DECISION WAS MADE TO PLACE BOTH THE GASTROSTOMY TUBE FOR DRAINAGE AND A SEPARATE JEJUNOSTOMY TUBE FOR FEEDING. before tacking to the anterior abdominal wall it was decided to create a cholecystojejunostomy. Once the anvil was placed a whipstitich was performed around the gallbladder and the other end of the eea was passed through. The 2 ends were brought together and the eea device was fired. when placing the drain the entire anastomosis fell apart so a hand anastomosis was performed instead.

thoughts on cpt codes would be great :)

SuperCoder Answered Thu 09th of August, 2012 21:59:39 PM

We are working on this. Please bear with us.

Thank You

Laura Posted Tue 14th of August, 2012 12:24:21 PM

any update? Thanks

SuperCoder Answered Tue 14th of August, 2012 13:51:30 PM

Hi Laura,

Code 47741 for cholecystojejunostomy. and 47100 for Liver Biopsy

Code 47741 includes gastrojejunostomy (CPT description states gastroenterostomy.... entero meaning small bowel, jejunum is small bowel.) 47741 includes gastrojejunostomy 43820

Code 49440 for gastrostomy tube placement.
Code 49441 for jejunostomy tube placement.

Thanks

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