fullerka
New
Hoping someone out there can help me with comp codes on the following report. Provider is wanting to use 43330 22 (Esophagomyotomy) but I feel like 43520 22 (Pyloromyotomy) is a more accurate description of what he is doing. He also wants more RVU's for things like endostitch, tunneling, injection and decompression but I feel like most of these things are included in base procedure description. I am new to G-POEM coding and would just like some opinions on how any of you might code this. Thank you!
NAME OF PROCEDURE:
Esophagogastroduodenoscopy, gastric per oral endoscopic myotomy.
MEDICATION:
General anesthesia.
DESCRIPTION OF PROCEDURE:
The GIF-H180 upper endoscope was passed from mouth to second portion of duodenum and gastric mucosa was visualized. Pylorus was visualized. Duodenum appeared to be normal. Gastric mucosa appeared to be normal, although there was increased peristalsis. Hence, 1 mg of glucagon was given intraprocedure. The GIF-H180 endoscope was attached to the distal Fujinon cap. The pylorus was visualized around 4 to 5 cm proximal to the pylorus using a 25-gauge Carr Locke needle submucosal injection was performed with ORISE gel. Then, using a DualKnife on the EndoCut mode, the gastric mucosa was incised in a deliberate fashion and a submucosal tunneling was created. Using a dual line J injection was made in the submucosal space and tunneling was performed. An upper endoscope was advanced with careful dissection of the submucosal space. There was small bleeding, which was cauterized with the help of a DualKnife in the coag mode. We were decompressing the stomach every 15 minutes. The duodenum and the pylorus were examined very closely for any mucosal defect. After advancing in the submucosal space we were able to identify the pyloric ring. The duodenal fold was visualized. Hence, an ITknife at a dual-cut setting. Careful muscle dissection was performed of the circular and longitudinal fibers up to the serosa. Following that scope was withdrawn from the tunnel and mucosa was carefully examined for any defect. After that, the scope was withdrawn and a 2D therapeutic upper endoscope was used with a Apollo EndoStitch device. The submucosal tunneling/mucosal defect, which was created the stitching was done from right to left. After that EndoStitch device was withdrawn. The mucosa was examined with an upper scope, there was a small defect seen, which was closed with 4 Microclips. After that mucosa was visualized and carefully examined and was satisfactory closure of the submucosal tunneling was seen.
COMPLICATIONS:
There were no complications of the procedure.
Procedure time was 80 minutes.
PROCEDURE CODE:
Unlisted procedure, EGD with an EndoStitch.
NAME OF PROCEDURE:
Esophagogastroduodenoscopy, gastric per oral endoscopic myotomy.
MEDICATION:
General anesthesia.
DESCRIPTION OF PROCEDURE:
The GIF-H180 upper endoscope was passed from mouth to second portion of duodenum and gastric mucosa was visualized. Pylorus was visualized. Duodenum appeared to be normal. Gastric mucosa appeared to be normal, although there was increased peristalsis. Hence, 1 mg of glucagon was given intraprocedure. The GIF-H180 endoscope was attached to the distal Fujinon cap. The pylorus was visualized around 4 to 5 cm proximal to the pylorus using a 25-gauge Carr Locke needle submucosal injection was performed with ORISE gel. Then, using a DualKnife on the EndoCut mode, the gastric mucosa was incised in a deliberate fashion and a submucosal tunneling was created. Using a dual line J injection was made in the submucosal space and tunneling was performed. An upper endoscope was advanced with careful dissection of the submucosal space. There was small bleeding, which was cauterized with the help of a DualKnife in the coag mode. We were decompressing the stomach every 15 minutes. The duodenum and the pylorus were examined very closely for any mucosal defect. After advancing in the submucosal space we were able to identify the pyloric ring. The duodenal fold was visualized. Hence, an ITknife at a dual-cut setting. Careful muscle dissection was performed of the circular and longitudinal fibers up to the serosa. Following that scope was withdrawn from the tunnel and mucosa was carefully examined for any defect. After that, the scope was withdrawn and a 2D therapeutic upper endoscope was used with a Apollo EndoStitch device. The submucosal tunneling/mucosal defect, which was created the stitching was done from right to left. After that EndoStitch device was withdrawn. The mucosa was examined with an upper scope, there was a small defect seen, which was closed with 4 Microclips. After that mucosa was visualized and carefully examined and was satisfactory closure of the submucosal tunneling was seen.
COMPLICATIONS:
There were no complications of the procedure.
Procedure time was 80 minutes.
PROCEDURE CODE:
Unlisted procedure, EGD with an EndoStitch.