Insertion jejunostomy and gastropexy...need CPT

maine4me

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Good morning everyone. I am having trouble determining a suitable CPT code for this procedure. At the moment I am leaning toward an unlisted code, 43999, but am uncertain how to use this same code for both procedures. Any help is appreciated.

PREOPERATIVE DIAGNOSIS: Large hiatal hernia with recurrent aspiration and need for enteral access.



POSTOPERATIVE DIAGNOSIS: Same.



OPERATION: Insertion of feeding jejunostomy and gastropexy.



PROCEDURE AND FINDINGS: The patient was brought to the Operating Room, properly identified, and place on the table in the supine position. Preop diagnosis, procedure and site were confirmed on time out. She had induction of general anesthesia via IV and orotracheal tube. She had preop antibiotics and she ahd sequential TEDs placed. Foley Catheter was in placed. The abdomen was prepped with ChloraPrep and after three minutes drapes were applied. Upper abdominal incision was made and carried down sharply. The abdomen was entered. The ligament of Treitz was found and duodenum was measured down approximately 30 cm and a mark was made at this site.



Attention was then turned to the stomach. The majority of her stomach was in her chest. The stomach was pulled down as much as possible until there was a good deal of resistance. The stomach was then pexied to the anterior abdominal wall with multiple silk sutures. No attempt was made to reduce the stomach completely because of the patient's underlying medical conditions and her advance age.



Once the gastropexy was finished, attention was turned to making the feeing jejunostomy. Balloon-tip silicone drain was tunneled the subcutaneous tissue and into the abdominal cavity in the left mid to upper abdomen. At the previously marked jejunum, a double pursestring suture of Vicryl was made and then the jejunum was opened and the catheter was placed into the jejunum. Approximately 15 cm of catheter extended beyond the balloon. The balloon was inflated with several cc of water and then the Vicryl pursestrings were tied down. A witzel tunnel was then created with intestinal silk. The jejunum was then snugged up to the underside of the abdominal wall and multiple Vicryl sutures were used to anchor the jejunum to the anterior abdominal wall and also decrease the chance of any leakage intra-abdominally. The collar was the snugged up to the anterior abdominal wall and a silk suture was used to secure the collar to the catheter itself. It was flushed with saline without difficulty. It was ascertained that there was no kinking of the small intestine and there was no bleeding.



The abdomen was then closed in layers with #1 PDS to the posterior fascia and #1 PDS in a running fashion to close the anterior fascia. Subcutaneous tissues were irrigated and then skin approximated with running subcuticular suture of 4-0 Monocryl. Steri-Strips were applied. Appropriate dressings were applied. Needle, sponge, and instrument count was correct x2 and blood loss was minimal. The patient left the Operating Room in stable condition, breathing on her own to recover in the PACU.
 
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