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Lap repair of perforated ulcer-HELP


Best answers
The only code I could find to use for this procedure is 43659 (unlisted laparoscopy procedure, stomach.
There is no RVU for this code.

Has anyone billed for this?
What was the price billed?
What was the reimbursement?

Here is the op note:

PREOPERATIVE DIAGNOSIS: Peritonitis, acute abdomen.
POSTOPERATIVE DIAGNOSIS: Perforated ulcer with exudate peritonitis.

PROCEDURE: Diagnostic laparoscopy and laparoscopic repair of a perforated
ulcer, abdominal washout, as well as drainage of abdominal wall fluid


INDICATIONS: The patient is a 52-year-old female with history of morbid
obesity and multiple comorbidities, who presented with complaint of severe
abdominal pain. Workup revealed findings consistent with peritonitis with
free intraperitoneal air. After discussing these findings with the patient,
decision was made to proceed with diagnostic laparoscopy. Consent was

PROCEDURE IN DETAIL: The patient was taken to the OR, placed on OR table
in supine position. Bilateral SCDs were placed. Anesthesia was induced.
The patient was intubated. Foley catheter was inserted. Abdomen was
prepped and draped in sterile techniques. A 5-mm incision was made in the
left upper quadrant. Veress needle was introduced in the abdomen and
abdomen was insufflated to a pressure of 15 mmHg. Veress needle was
removed and replaced with a 5-mm trocar. A 5-mm 30-degree camera was
introduced into the abdomen and 3 additional trocars were placed under
direct vision. This included 11-mm left paramedial trocar, 12-mm right
paramedial trocar and 5-mm right upper quadrant trocar. The patient was
then placed in steep reverse Trendelenburg position with right side up.
On initial inspection, the patient was noted to have large amount of
exudative fluid as well as fibrinous changes throughout the upper abdomen.
All this was aspirated.

On further inspection, the patient was noted to
have a hole in the distal stomach measuring approximately 5 to 7 mm in
diameter. We then proceeded with the repair of this perforation using
Endostitch. 2-0 Surgidac stitches were applied to close this opening in 2
layers. A Graham patch was then placed, followed by the application of
Evicel. The abdomen was subsequently irrigated with copious amount of
fluid. Two Blake drains were placed, one in the pelvis and one by the
repair site, and brought out through the 5-mm trocar sites. The abdomen
was then reinspected. There was no active bleeding or oozing. The 12-mm
and 11-mm trocar sites were closed with 0 Vicryl stitch using suture
passer. The abdomen was desufflated. Trocar sites were approximated with
4-0 Vicryl followed by Steri-Strips. Anesthesia was withdrawn. The
patient was extubated and transferred on a stretcher to the recovery room. The
patient tolerated procedure well. There were no complications.

Has anyone billed for this?
What was the price billed?
What was the reimbursement?