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Prodecure Help

Simone Posted Tue 31st of August, 2010 11:26:00 AM

Can anyone please help me code this? The physician stated he entered the chest cavity using all my other trocar siteds from the previous surgery. He instered a fan retractory to see the gastic conduit and perfomred a edoscopic gastroduodenoscopy where he left the scope in the patient's esophas for good position. then with a pair of shar scissors to trasect the anastomosis and the gastroesophagel anastomosis, then revomed the stale lin in its entirelty. He transected about 0.5mm of proximal esophasus and 0.5cm of the disal stomach. The he removed the ring and rescoped the patient. He noticed a twist in the stomach and he untwisted the stomach to gain patency of the gastic conduit. He rescoped the patient and could see that we had completley untwisted the stomach. He then used marker to mark the lateral surface of this gastric conduit so that we could not be twistng the area. He pulled back the
EGD and placed an anvil of the 28 EEA stapler into the proximal esophasus and secured it inplace using a double row of pursestring suture.He then placed the EEA stapler directly into the thorascoscopy site and I was able to pass the EEA stapler into the proximal end of the stomach. He pulled the stomach up along the shaft of the EEA stapler and was able to deploy my needle through the posterior wall of the stomach. I then connected the pin to the anvil and was able to fire the EEA stapler across the entire region to comple the gastroesophageal anastomosis. I pulled ot the EEA stapler and checked the doughnuts. At the distal end of the gastric conduit, I used Endo-GIA blue loader stapler to transect the top part of the stomach. The end of the gastric remnant was then passed off the field as a specimen.He copioulsy irrigated the patients chest cavity using 3 liters of bacitracion fortified solution, suchtioned off the entire chest cavity. He place a 10-French JP drainposterior to the esophagus. He also did a multilevel intracostal ner block using .025% of Marcaine, and I place the chest tube into the posterior medial recess of the chest cavity. I then went back to his mouth to re-scope the patient again to confirm that I had adequately detorsed the stomach and the stomach was completley in a straight line all the way down to the diaphragmatic pinch. He was able to cross the diaphragmatic inch easilyk and enter the patient's plyorus. There was no evidence of any torsion at all. I desufflated the stomach and placed the NG tube myself without any difficulty.

The physician is coding 43235,43289 and 43659 us this correct?


SuperCoder Answered Wed 01st of September, 2010 09:24:48 AM

Hi Simone,

Glad to help with your question. I'm checking with the consulting editor of Gastroenterology Coding Alert for the expert's advice. I'll let you know as soon as I get a reply.

Warm regards,
Claire (Gamboa)
Editor, GAC

Simone Posted Wed 01st of September, 2010 12:58:29 PM

Thank you

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