47562 w/ lap gastrostomy for ERCP


Escondido, CA
Best answers
43653 is bundled w/47562. Would it be appropriate to use an unlisted code, 43659 when there's the 43653 (I know guidelines indicate no) however if there is something I'm missing in the op report, I wanted to put that out there. I didn't keep the entire chole in the op report as that goes w/o saying or seeing:

The Optivew system was then used to gain access to the peritoneal cavity.
The peritoneal cavity was insufflated to 15 mmHg and initial examination of intraabdominal organs was
performed, which revealed significant adhesions in the upper abdomen. Two additional 5 mm ports
were inserted in the right flank and 12 mm port was inserted 5 cm
below the xiphoid process in the midline.

meticulous and long lysis of adhesions was performed with sharp and blunt dissection.
Adequate exposure of the upper abdomen was then achieved. 3-0 Vicryls stitch was then used to perform a pursestring
On the anterior wall of the stomach, 8 cm from the pylorus. 3 additional stay sutures were placed around the pursestring
And were brought out through stab incisions in the left upper quadrant. The stay sutures were placed to provide countertraction
For the EGD. After that, 2 cm incision was made in the left upper quadrant, and the EGD scope was inserted through the abdominal wall
And into the gastrotomy. The pursestring was then tightened around the scope to provide a good seal.
The ERCP was then performed. Please refer to a separate report for this part of the procedure.
after the ERCP was completed, the EGD scope was removed, and the gastrotomy was evaluated. It was found to be hemostatic.
The anterior wall of the stomach was elevated with the stay sutures, and a single load Endo GIA stapler was used
To close the gastrotomy. Adequate staple line was noted. No bleeding or gastric content leak were noted.
The suture line was then imbricated with several interrupted 3-0 Vicryl sutures. the stay sutures were removed.

the attention then was turned to the gallbladder. The gallbladder was