Fistula closure in Esophagus wall

vcrystalj

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Good Afternoon!
I have this case that I would appreciate any input provided. The physician completed a fistula closure endoscopically in the esophagus wall. I have researched it online and the only code I have found was CPT 43870 but this codes states that it is completed by an incision around the gastrostomy site. Has anyone had any similar cases? I would greatly appreciate any suggestions you may have. I have attached a copy of the report.

Procedure Performed: EGD - Diagnostic (43235)

Pre-procedure diagnosis: * K22.3 Perforation of esophagus

Medications/Anesthesia Type: * Per Anesthesia Report
Visualization: *Good
Tolerance: *Good
Complications: *None
Estimated Blood Loss: *None

Extent of Exam: Second Part of Duodenum
Limitations: * None
Procedure Technique: *A physical exam was performed. Informed consent was
obtained from the patient after explaining all the risks (perforation, bleeding,
*infection and adverse effects to the medicine) , benefits and alternatives to
the procedure which the patient appeared to understand and so stated. *The
patient was connected to the monitoring devices and placed in the left lateral
position. Continuous oxygen was provided with a nasal cannula and IV medicine
administered through a indwelling cannula. After adequateconscious sedation was
achieved, the patient was intubated and the scope advanced under direct
visualization to the Second Part of Duodenum.
The Second Part of Duodenum was identified by visual landmarks. The scope was
subsequently removed slowly while carefully examining the color, texture,
anatomy, and integrity of the mucosa on the way out. The patient was
subsequently transferred to the recovery area in satisfactory condition.
The following findings were noted:

Findings:
Normal esophageal mucosa.

6mm fistulous tract identified in the wall of the esophagus immediately proximal
*to the GE junction.
The fistula tract was then targeted for closure with the Over the scope clip
system (OTSC). *The fistula *opening was placed at the center of the endoscopic
cap, while appling firm suction through the endoscopic channel allowing the
surrounding tissue*to be suctioned into the endoscopic cap. *The 12/6a clipping
device was deployed by turning the firing wheel attached to the endoscope
handle.
Post deployment the defect could be seen successfully secured within the clip.

Recommendations:
NPO until UGI series which should be performed tomorrow.
 
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