Ex lap, lysis of adhensions, gastrostomy for transgastric ERCP w/ gastrostomy closure

nlbarnes

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Doc is using 43659 but I can't help but think there might be something else appending with modifer 52, such as 43653. I'm super tired.

Again, after quite a long time of dissection, more than about 45 minutes, we were finally
able to identify the remnant stomach. This was not much able to be
dissected free as it was densely adherent to the liver, so we did
finally able to identify the greater curvature of the remnant stomach.
At this point, we used 2-0 Surgidac suture to place two sutures on the
greater curvature of the stomach and then we placed a 15 trocar in the
left upper quadrant. We used the Harmonic scalpel to make a
gastrotomy in the stomach and then guided the 15 trocar into the
stomach at this location and then hoisted two 2-0 Surgidac sutures,
which we then passed through transabdominally with the Endo Close
device. We hoisted this up against the abdominal wall. I refer you
to Dr. Reidel's dictation about the ERCP which was done through the 15
mm trocar. Once they were completed, we removed the suspension
sutures and then closed the gastrotomy using 2 layer closure with 2-0
Polysorb suture and 2-0 Surgidac suture. When this was completed, we
did look around. Again, as I mentioned, we tried to evaluate the
gallbladder and the right upper quadrant, but there were too many
adhesions from the previous surgery and copious inflammation from the
gallbladder, so was not able to be visualized.
 

CodingKing

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Don't forget the modifier 22 for the excessive adhesions. extra 45 min may or may not be enough to get a bump on the reimbursement but wont hurt to try.
 

nlbarnes

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https://www.aapc.com/memberarea/forums/137996-ex-lap-lysis-adhensions-gastrostomy-tra

Hi CodingKing. So that's a yes on the 43653-52-22? Not the unlisted, right? Can you modify an unlisted out of curosity in general?
 
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CodingKing

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I'm not even sure about codes. Is it normal to do a gastrostomy in order to complete a ERCP? Is this normally a procedure that requires co-surgeons? What services were reduced the ECRP?

As to Modifiers on Unlisted codes. Here is the best way to look at it. Modifiers are used to indicate a service or procedure that has been performed has been altered by some specific circumstance but has not changed in its definition or code. Since an unlisted code has not been defined there is noting to modify.
 
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