Gastrocutaneous Fistula Closure

[rrrobinson05]

Is there a specific CPT code for Gastrocutaneous fistula closure? I did look at 44650, this is not what was done.
There is another forum on this subject, but it was never answered or clarified. I'm hoping someone will help. Do we use 44650 -52? Here's the Op Note:

Indications: ___________is a 12 m.o. male presenting with a g-tube site that has not spontaneously closed.

Operative Details: __________ was brought to the operating room where they underwent general anesthesia. __________ was then prepped and draped in the usual fashion. Attention was directed to the gastrocutaneous fistula. An elliptical incision was made around the previous gastrostomy site. The tract was then separated from the surrounding subcutaneous tissue, fascia, and rectus muscle using a combination of sharp and electrocautery dissection. The anterior wall of the stomach was delivered into the wound and the tract was then divided with a 30 mm TA stapler and passed off the field. The stomach was returned to the abdomen. The fascia and rectus muscle were approximated with interrupted 2-0 PDS sutures. Subcutaneous tissue was closed with vicryl and the skin was closed with monocryl The wound was dressed steri-strips. There were no apparent complications and the procedure was well tolerated.

Thanks to those who take the time to help with the forums.

 

[nickelclaw]

43870 don't let fistula throw you off. This is just a closure of gastrostomy.
Coder desk reference description states, "Physician closes a gastrostomy no longer needed. Physician enters through a previous gastrostomy.
Stomach is dissected free of abdominal wall. The stomach gastrostomy site is closed with sutures. The abdominal incision is closed with layered sutures."

If this was a gastrocolic fistula then 43880.
44650 is for a small bowel fistula or between small bowel and colon.

 

[rrrobinson05]

43870 don't let fistula throw you off. This is just a closure of gastrostomy.
Coder desk reference description states, "Physician closes a gastrostomy no longer needed. Physician enters through a previous gastrostomy.
Stomach is dissected free of abdominal wall. The stomach gastrostomy site is closed with sutures. The abdominal incision is closed with layered sutures."

If this was a gastrocolic fistula then 43880.
44650 is for a small bowel fistula or between small bowel and colon.

Thank you.

 

[nickelclaw]

Your very welcome

 

[bestrada10]

Your very welcome

Hi Nichole! I know this is an old thread but do you (or anyone reading) happen to know how this changes in regards to closure of a gastrocutaneous fistula instead of gastrocolic fistula? It's my understanding these are different with gastrocutaneous being fistula from stomach to skin and gastrocolic being stomach to intestine/colon. I'm also wondering on the ICD10 for this but leaning toward K31.89.

Op note is as follows:

He was placed in a supine position prepped and draped in a sterile fashion a timeout was performed antibiotics were given. At this point time we made an elliptical incision around the gastrocutaneous fistula approximately 3 cm in length. This is deepened through the skin and subcutaneous tissue using electrocautery we took all layers down into the abdominal cavity. We mobilized the stomach completely off of the anterior abdominal wall we used to stay stitches to hold the stomach and then transected the gastrocutaneous fistula and sent for pathology. We ran the mucosal layer with a 3-0 Vicryl suture we did inverted Lembert stitches as a second layer to close the stomach. We then dropped the stomach into the end abdominal wall and closed the posterior fascia using a running 2-0 PDS suture. We then closed the anterior using a running 2-0 PDS. All counts were correct finger sweep was done visual sweep done prior to closure. We did inject a total of 9 cc of quarter percent plain Marcaine into the wound. We then closed the Scarpa layer with interrupted 3-0 Vicryl suture for the deep dermal layer with interrupted 3-0 Vicryl suture and then ran the skin with a 4 oh PS2 Monocryl. Half-inch stereos and nasty Mastisol were used as a dressing.