General Surgery Coding Alert

Reviewed on May 20, 2015
Question: What is the correct code for a Graham patch omentoplasty used to repair a perforated duodenal ulcer? According to the operative report, the omentoplasty was performed after placing Lembert sutures of 3-0 silk. The stitch was left open, and a tongue of omentum was then placed over the ulcer and tied down with stitches. General Surgery Discussion List Participant   Answer: The Graham patch uses sutures placed on either side of the perforation lemberted with the addition of the omentum. The surgeon uses sutures to secure the patch and close the perforation. CPT® contains no specific code to describe Graham patch omentoplasty and the AMA and most coding experts advise against choosing "the next best" CPT® code when reporting procedures without a distinct CPT® code. Although you may contact individual carriers for instructions in some circumstances generally if the service you provide is not included in CPT® the best code choice is an unlisted-procedure code (e.g. 44799, Unlisted procedure, small intestine). Use of the unlisted-procedure code should alert the payer that the claim requires individual attention. Be sure to include complete documentation explaining the procedure in full, including the time and supplies involved. It may be helpful to compare the surgery to another similar procedure (e.g. 43840 Gastrorrhaphy suture of perforated duodenal or gastric ulcer wound or injury) to give the payer a "point of reference" to make a payment determination. The payer will use this information to determine payment.     "