HELP Coding Robotic assisted mobilization of the stomach & Open partial gastrectomy

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HELP Coding Robotic assisted mobilization of the stomach & Open partial gastrectomy

Hello Can anyone help me code this case? I am not familiar....

DATE OF PROCEDURE:
May 19, 2016

SURGEON:
AK, MD

PREOPERATIVE DIAGNOSIS:
Neoplasm of lesser curvature gastric 2.5 cm.

POSTOPERATIVE DIAGNOSIS:
A 2.5 cm neoplasm in the gastroesophageal junction, retroperitoneal peripancreatic nodule.

PROCEDURE PERFORMED:
1. Robotic assisted mobilization of the stomach.
2. Open partial gastrectomy with secondary margins.
3. Frozen section.
4. Excision of retroperitoneal peripancreatic nodule.

ASSISTANT:
AK, CST/CFA

ANESTHESIA:
General.

PROCEDURE DETAILS:
With the patient under satisfactory endotracheal general anesthesia, the anterior abdomen was draped and prepped in the usual fashion. Patient identification and the proposed procedure were confirmed by the operative team. The patient received the usual prophylactic antibiotic and anticoagulation regimens.

A supraumbilical incision was used to enter the peritoneal cavity and place a Hasson cannula. Insufflation to 14 mm of CO2 produced adequate expansion. The optical system was put in position. There was no evidence of injury on penetration, but extensive adhesions from previous laparotomy precluded partial visualization of the area. We placed 3 additional 8 mm ports and a Nathanson 5 mm port retractor below the xiphoid to retract the left lobe of the liver. Once access had been obtained, the console was then utilized with the da Vinci system. We mobilized the lesser and greater curvature of the stomach up to the gastroesophageal junction and could not identify the lesion from the serosal aspect. An area of induration in the retroperitoneum and the gastrohepatic ligament was identified, which was mobilized for further evaluation and it was indeterminate. There appeared to be a 1 cm nodule in front of the pancreas suspicious for metastatic disease. The rest of the exploration appeared to be unremarkable. Using the vessel sealer, we mobilized both the lesser and greater curvatures, preserving the left gastric vessels. With the inability to identify externally the lesion, robotic surgery was then terminated and could not be achieved; therefore, the instrument was removed. Pneumoperitoneum was evacuated. We performed a medial laparotomy from the xiphoid to 2 cm below the umbilicus. A self-retaining retractor was placed in position. Digital examination and completion of mobilization of the greater curvature allowed identification of a 2.5 cm mass close to the junction with the gastroesophageal area on the lesser curvature of the stomach. A 1 cm nodule in front of the pancreas was removed and submitted to Pathology, proved to be exophytic pancreatic normal tissue. We then, using the Endo GIA, made 2 applications with the intestinal load to remove this lesion by performing a partial gastrectomy in the upper portion of the stomach towards the lesser curvature. The margins appeared to be clear except for 1 area; therefore, we made a 2nd passes of the staple device to completely remove and obtain negative margins. This area was not oversewn since hemostasis appeared to be adequate. The nasogastric tube had been placed in position for decompression of the stomach and was left in place at the completion of the procedure. A 19 Blake drain was left into the peripancreatic area, exteriorized through one of the lateral port sites, and secured to the skin with 3-0 nylon sutures. The sponge count x2 was correct. The fascia was closed with running sutures of #1 PDS double-stranded and the skin with staples. The patient was awakened and transferred to the recovery room in stable condition.

ESTIMATED BLOOD LOSS:
150 cc.

COMPLICATIONS:
There were no significant intraoperative complications
 

mmorningstarcpc

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Robotic Assistance

You would code the procedures normally as if the robotic assistance was not used. CPT does not recognize robotic assistance except in a very few instances and then you will see robotic assistance in the code description. There is a HCPCS code S2900 for surgical technique robotic system, however, most payers do not accept that code. You may want to review payer coverage policies for your carriers.

Hello Can anyone help me code this case? I am not familiar....

DATE OF PROCEDURE:
May 19, 2016

SURGEON:
AK, MD

PREOPERATIVE DIAGNOSIS:
Neoplasm of lesser curvature gastric 2.5 cm.

POSTOPERATIVE DIAGNOSIS:
A 2.5 cm neoplasm in the gastroesophageal junction, retroperitoneal peripancreatic nodule.

PROCEDURE PERFORMED:
1. Robotic assisted mobilization of the stomach.
2. Open partial gastrectomy with secondary margins.
3. Frozen section.
4. Excision of retroperitoneal peripancreatic nodule.

ASSISTANT:
AK, CST/CFA

ANESTHESIA:
General.

PROCEDURE DETAILS:
With the patient under satisfactory endotracheal general anesthesia, the anterior abdomen was draped and prepped in the usual fashion. Patient identification and the proposed procedure were confirmed by the operative team. The patient received the usual prophylactic antibiotic and anticoagulation regimens.

A supraumbilical incision was used to enter the peritoneal cavity and place a Hasson cannula. Insufflation to 14 mm of CO2 produced adequate expansion. The optical system was put in position. There was no evidence of injury on penetration, but extensive adhesions from previous laparotomy precluded partial visualization of the area. We placed 3 additional 8 mm ports and a Nathanson 5 mm port retractor below the xiphoid to retract the left lobe of the liver. Once access had been obtained, the console was then utilized with the da Vinci system. We mobilized the lesser and greater curvature of the stomach up to the gastroesophageal junction and could not identify the lesion from the serosal aspect. An area of induration in the retroperitoneum and the gastrohepatic ligament was identified, which was mobilized for further evaluation and it was indeterminate. There appeared to be a 1 cm nodule in front of the pancreas suspicious for metastatic disease. The rest of the exploration appeared to be unremarkable. Using the vessel sealer, we mobilized both the lesser and greater curvatures, preserving the left gastric vessels. With the inability to identify externally the lesion, robotic surgery was then terminated and could not be achieved; therefore, the instrument was removed. Pneumoperitoneum was evacuated. We performed a medial laparotomy from the xiphoid to 2 cm below the umbilicus. A self-retaining retractor was placed in position. Digital examination and completion of mobilization of the greater curvature allowed identification of a 2.5 cm mass close to the junction with the gastroesophageal area on the lesser curvature of the stomach. A 1 cm nodule in front of the pancreas was removed and submitted to Pathology, proved to be exophytic pancreatic normal tissue. We then, using the Endo GIA, made 2 applications with the intestinal load to remove this lesion by performing a partial gastrectomy in the upper portion of the stomach towards the lesser curvature. The margins appeared to be clear except for 1 area; therefore, we made a 2nd passes of the staple device to completely remove and obtain negative margins. This area was not oversewn since hemostasis appeared to be adequate. The nasogastric tube had been placed in position for decompression of the stomach and was left in place at the completion of the procedure. A 19 Blake drain was left into the peripancreatic area, exteriorized through one of the lateral port sites, and secured to the skin with 3-0 nylon sutures. The sponge count x2 was correct. The fascia was closed with running sutures of #1 PDS double-stranded and the skin with staples. The patient was awakened and transferred to the recovery room in stable condition.

ESTIMATED BLOOD LOSS:
150 cc.

COMPLICATIONS:
There were no significant intraoperative complications
 
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