Wiki Graham Patch For Duodenal Ulcer

[Robin R]

Does anyone have any suggestions for coding a Graham patch to repair a duodenal ulcer?

Would it be 43840 or add-on 49905? Am I close???

Thanks for any advice!

 

[mjewett]

I believe you are correct. This is how I code for Graham Patch repair of a duodenal ulcer.
Melissa CPC

 

[Robin R]

I believe you are correct. This is how I code for Graham Patch repair of a duodenal ulcer.
Melissa CPC

Do you use both CPTs?

Thank you very much for your help.

 

[mjewett]

Yes, I use both 43840 and add-on 49905. 43840 is the suture repair of a duodenal ulcer... and code 49905+ is the omental flap intra-abdominal. The doctor creates the omental flap and sutures it to the site of the duodenal ulcer/wound to repair it.

I use to get tripped up over this one too.

Melissa-CPC

 

[Robin R]

Thank you so much!

 

[Melissa*Ever*Evolving]

Billed as you show above and received denial from Medicare stating this is not a valid primary procedure for 49905. They recognize 43840 as payable, but not 49905 stating no appropriate primary procedure billed. (This went to appeal and all)
Any suggestions?

~Melissa Rufenbarger, CPC

 

[cynthiabrown]

actually my doc told me the patch is included with the procedure a FLAP wouldbe something way more extensive than a simple patch

 

[jroxas]

duodenorraphy with graham patch

Hi
We can code 43840 with 49905 (intraabdominal omental flap) There is no bundling issue per NCCI edits

Jerry E. Roxas, CPC