Endoscopic sub mucosal dissection - CPT Code 43499????


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Need some assistance on coding this OP Report

Brief description - pt has Barrett's esophagus and reflux, now has developed several small nodules

OP Report - We washed the esophagus. We then identified the lesions. We then used concentrated methylene blue to denote the distal extent of the lesions, then we marked with cautery circumferentially around the lesions.

We then injected and lifted the mucosa at the top. We then made a mucosotomy and got down into the submucosal space. Several large longitudinal blood vessels were encountered and had to be coagulated. then we sort of cut out the U. As the mucosa folded over, were able to cut down and resect the lesions. as we got down to the dark blue staining, after taking down the entire submucosal space, we placed a snare around it. i thought we were completely around, but we ended up dividing it just proximal to the distal extent. We removed that specimen. We then went back and then re-resected the distal lesion.

We then checked for hemostatis. There was a single blood vessel that was exposed. We cauterized it with the grasping forceps. Everything else seemed to be intact. We then suctioned out the stomach. We removed the scope.