Hi,
I'm new to coding and have 'inherited' our MIS division, and don't necessarily agree with the way that these were being coded. I've researched our past cases and either 49450 or 44373 is being assigned what seems like randomly on different cases, from what I can see all with near-identical situations. It's come up a few times now, and I'm following instructions, but just wanted to get other opinions or some rationale to help explain.
current case:
OPERATION PERFORMED: EGD with removal and replacement of GJ tube (downsized gastrostomy portion to 20-French from 24-French). Fluoroscopy.
The patient was placed on the operating room table in the supine position. Anesthesia was induced via a general endotracheal approach. A surgical safety time-out was performed with no issues. Under direct endoscopic visualization, a GIF-HQ190 gastroscope was advanced through the oropharynx into the esophagus. There was a small hiatal hernia. We entered the stomach, which had an air-fluid level of bile and moderate-to-severe bile reflux gastritis throughout the entire stomach. The G-tube was in a good position. I withdrew the jejunal portion under direct visualization. We then advanced an endoscopic snare through the G-tube and out through the abdominal wall. I removed the G-tube under traction allowing the snare to remain outside the skin. We opened the snare, placed a guidewire into it and retrieved the endoscope and guidewire through the mouth. A 20-French gastrostomy tube was secured to the wire and using a standard Ponsky pull method, the 20-French gastrostomy was pulled into position with the gastroscope following. We placed the external bumper. Again, the distance at the skin was about 5.5 with the patient supine. We left an additional 5 mm leaving it at 6 cm from the skin to accommodate for tension when the stomach is deflated and when the patient is sitting upright. This mirrored the depth at which the old bumper was pulled from as measured externally. We then advanced a 12-French jejunal feeding extension into the tube. This was grasped with an endoscopic snare and dragged post-pyloric to beyond the ligament of Treitz. It was clipped twice to the mucosa and brought back utilizing endoscopic and fluoroscopic guidance. Representative fluoroscopic images were saved. The tube made a small gentle loop in the proximal stomach and was at the ligament of Treitz and clipped in position on the final image
I'm new to coding and have 'inherited' our MIS division, and don't necessarily agree with the way that these were being coded. I've researched our past cases and either 49450 or 44373 is being assigned what seems like randomly on different cases, from what I can see all with near-identical situations. It's come up a few times now, and I'm following instructions, but just wanted to get other opinions or some rationale to help explain.
current case:
OPERATION PERFORMED: EGD with removal and replacement of GJ tube (downsized gastrostomy portion to 20-French from 24-French). Fluoroscopy.
The patient was placed on the operating room table in the supine position. Anesthesia was induced via a general endotracheal approach. A surgical safety time-out was performed with no issues. Under direct endoscopic visualization, a GIF-HQ190 gastroscope was advanced through the oropharynx into the esophagus. There was a small hiatal hernia. We entered the stomach, which had an air-fluid level of bile and moderate-to-severe bile reflux gastritis throughout the entire stomach. The G-tube was in a good position. I withdrew the jejunal portion under direct visualization. We then advanced an endoscopic snare through the G-tube and out through the abdominal wall. I removed the G-tube under traction allowing the snare to remain outside the skin. We opened the snare, placed a guidewire into it and retrieved the endoscope and guidewire through the mouth. A 20-French gastrostomy tube was secured to the wire and using a standard Ponsky pull method, the 20-French gastrostomy was pulled into position with the gastroscope following. We placed the external bumper. Again, the distance at the skin was about 5.5 with the patient supine. We left an additional 5 mm leaving it at 6 cm from the skin to accommodate for tension when the stomach is deflated and when the patient is sitting upright. This mirrored the depth at which the old bumper was pulled from as measured externally. We then advanced a 12-French jejunal feeding extension into the tube. This was grasped with an endoscopic snare and dragged post-pyloric to beyond the ligament of Treitz. It was clipped twice to the mucosa and brought back utilizing endoscopic and fluoroscopic guidance. Representative fluoroscopic images were saved. The tube made a small gentle loop in the proximal stomach and was at the ligament of Treitz and clipped in position on the final image