Good afternoon, I am getting conflicting information if coding this as a 43860 or 44120 is correct. Coders are debating 43860 is for a stomach procedure and a jejuno-jejunal is a small bowel so 44120, 44121 would be correct. While others are making the argument that 44120, 44121 is incorrect as it is a revision of the Roux limb, pancreatic limb & common limb to address the strictured jejuno-jejunal anastomosis from a bypass procedure. any guidance would be greatly appreciated.
DESCRIPTION OF PROCEDURE(S):
Immediately after entering the OR a pre-induction checklist was completed to verify correct patient, surgery and surgical site. The patient underwent an uneventful induction and intubation. The patient was then placed supine with arms open to 90 degrees. The abdomen was prepared with ChloraPrep following the manufacturer's instructions and draped in a standard sterile fashion.
A pre-incision checklist was completed. A midline laparotomy performed which required careful dissection as there were dense adhesions necessitating meticulous dissection to avoid catastrophic injury to intraabdominal contents. Once we were able to complete the laparotomy we continued lysing adhesions to separate the bowel and omentum from the abdominal wall. We then placed our retractor.
We continued lysing adhesions to mobilize the bowel from the ligament of Treitz to the ileocecal valve. Adhesions were dense and fibrotic making it difficult to accurately distinguish planes. This process took well over an hour and significantly increased the complexity of the case. As we mobilized the bowel we identified an internal hernia under the previous anastomosis. The internal hernia was reduced the bowel was viable. The jejuno-jejunal anastomosis was not strictured due to dense scare tissue surrounding with proximal dilatation of bowel and distal decompression thus decision to perform a resection was made.
We used an EndoGIA 60 mm stapler to divide the Roux limb, pancreatic limb and the common limb. We then reanastomosed the pancreatic and common limbs using an EndoGIA 60 mm stapler with blue loads using the stapler for both the anastomosis and closure of the common channel. We then anastomosed the Roux limb distal to the previous anastomosis using an EndoGIA 60 mm stapler blue load for the anastomosis and 3-0 PDS suture for closure of the common channel. We re-inforced the anastomoses with Lambert sutures and VistaSeal.
We washed the abdomen with Irisept. Placed a 19 Fr drain under the transverse colon near the anastomoses. We secured the drain to the skin with 2-0 Nylon. We then closed the abdomen with running 0 PDS for the fascia and staples for the skin.
DESCRIPTION OF PROCEDURE(S):
Immediately after entering the OR a pre-induction checklist was completed to verify correct patient, surgery and surgical site. The patient underwent an uneventful induction and intubation. The patient was then placed supine with arms open to 90 degrees. The abdomen was prepared with ChloraPrep following the manufacturer's instructions and draped in a standard sterile fashion.
A pre-incision checklist was completed. A midline laparotomy performed which required careful dissection as there were dense adhesions necessitating meticulous dissection to avoid catastrophic injury to intraabdominal contents. Once we were able to complete the laparotomy we continued lysing adhesions to separate the bowel and omentum from the abdominal wall. We then placed our retractor.
We continued lysing adhesions to mobilize the bowel from the ligament of Treitz to the ileocecal valve. Adhesions were dense and fibrotic making it difficult to accurately distinguish planes. This process took well over an hour and significantly increased the complexity of the case. As we mobilized the bowel we identified an internal hernia under the previous anastomosis. The internal hernia was reduced the bowel was viable. The jejuno-jejunal anastomosis was not strictured due to dense scare tissue surrounding with proximal dilatation of bowel and distal decompression thus decision to perform a resection was made.
We used an EndoGIA 60 mm stapler to divide the Roux limb, pancreatic limb and the common limb. We then reanastomosed the pancreatic and common limbs using an EndoGIA 60 mm stapler with blue loads using the stapler for both the anastomosis and closure of the common channel. We then anastomosed the Roux limb distal to the previous anastomosis using an EndoGIA 60 mm stapler blue load for the anastomosis and 3-0 PDS suture for closure of the common channel. We re-inforced the anastomoses with Lambert sutures and VistaSeal.
We washed the abdomen with Irisept. Placed a 19 Fr drain under the transverse colon near the anastomoses. We secured the drain to the skin with 2-0 Nylon. We then closed the abdomen with running 0 PDS for the fascia and staples for the skin.