Eleen Posted Wed 09th of November, 2016 09:33:39 AM
A 5 mm x 10 mm fistula was found in the proximal esophagus approximately 16 to 17 cm from the incisors. A clear tract was identified from the esohpagus to the larengectomy site with extension to the anterior skin. This was probed for confirmation. Two suture strings were inserted in the cutaneous aspect of the tract and grasped with a snare and pulled through the mouth. The tract was then ruffed up with a cytobrush to help with wound healing. Two cook biodesign 7 mm x 5.1 cm fistula plugs wee tied to the strings and pulled into place through the mouth under endoscopic guidance, with the
silastic disk on the esophageal side of the fistula. These were trimmed and secured to the skin aspect with 2-0 vicryl suture. An 025 inch angle tipped visiglide wire was then placed in the stomach under fluoroscopic guidance. The fistula site was then stented across with a 10 mm x 8 cm fully covered metal Viabil stent. under fluoroscopic guidance with proximal margin of the stent 2 cm above the fistula. Contrast was injected via an inflated retrieval balloon for a limited esophagram with no leak or reflux of contrast.
A tracheoesophageal prosthesis was found in the upper third of the esophagus this was covered by the stent.
There was evidence of an intact gastrostomy with an occluded j extension-tube present in the gastric body. A scout image was obtained showing tube in position. attempts at unclogging the tube with various wires was unsuccessful and the tube was removed. a well lubricated N 180 ultrathin endoscope was used via the G tube and was advanced to the 2nd portion of
the duodenum. Under fluoroscopic guidance an 0.035 inch stiff Jagwire was advanced 4th portion of the jejunum but due to looping when the tube was advanced access to small bowel was lost. this process was repeated multiple times with various wires. Eventulally the a new 12 Fr J extension was placed in the 2nd portion of the duodenum and was capped. Position was confirmed with fluoroscopy. The ampulla, duodenal bulb, 2nd part of the duodenum and 3rd part of the duodenum were normal. Do I code 43235-44799
SuperCoder Answered Thu 10th of November, 2016 02:24:00 AM