Callieb
Guest
Dr's short version of surgery is "Partial duodenectomy and gastrectomy with Heineke-Mikulicz pyloroplasty type repair. Dissection of the porta hepatis nodes"
I am thinking this is a small bowel resection 44120 and pyloroplasty 43800. Can I code for the nodes? Here is the main part of the op note.
Nodule identified on antherior duodenal bulb. Dissection carried out mobilizing and kocherizing the duodenum laparoscopically. After kocherization of duodenum, head of pancreas, some dissection was carried out in porta freeing up peritoneum and anterior nodal material from underlying common bile duct and hepatic vessels. AT THIS TIME CONVERTED TO OPEN. Incision made, muscle split instead of divided, in posterior fashion, incised and protractor inserted into wound. We had enough mobility of duodenum to pull into wound. Remaining attachments to porta hepatis anteriorly of duodenum were freed up to head of pancreasand swept inferiorly. This materior was then; exicsed with scalpal and sent for permanent path. Further dissection carried out in porta and posterior nodes in and around head of pancreas bile duct were dissected free and sent for path. Stay sutures placed around tumor by approx 2cm marg. and paddle of tissue was excised of anterior superior duodenum and carried into the stomach excising part of pylorus and distal gastric wall. Sent for path. Heineke-Mikulicz pyloric reconstruction was carried out in two layers.
Any help or insight appreciated.
I am thinking this is a small bowel resection 44120 and pyloroplasty 43800. Can I code for the nodes? Here is the main part of the op note.
Nodule identified on antherior duodenal bulb. Dissection carried out mobilizing and kocherizing the duodenum laparoscopically. After kocherization of duodenum, head of pancreas, some dissection was carried out in porta freeing up peritoneum and anterior nodal material from underlying common bile duct and hepatic vessels. AT THIS TIME CONVERTED TO OPEN. Incision made, muscle split instead of divided, in posterior fashion, incised and protractor inserted into wound. We had enough mobility of duodenum to pull into wound. Remaining attachments to porta hepatis anteriorly of duodenum were freed up to head of pancreasand swept inferiorly. This materior was then; exicsed with scalpal and sent for permanent path. Further dissection carried out in porta and posterior nodes in and around head of pancreas bile duct were dissected free and sent for path. Stay sutures placed around tumor by approx 2cm marg. and paddle of tissue was excised of anterior superior duodenum and carried into the stomach excising part of pylorus and distal gastric wall. Sent for path. Heineke-Mikulicz pyloric reconstruction was carried out in two layers.
Any help or insight appreciated.