Ligation of Multiple portal systemic collaterals


Buffalo, NY
Best answers
I have a surgery case that I have not come across before:
A patient with severe alcoholic cirrhosis originally presented for an upper endoscopy for massive upper GI bleeding. During the course of the procedure, the bleeding was unable to be controlled and the patient's hemoglobin, hematocrit and vital signs became unstable. They were rushed to surgery for exploratory laporotomy wich revealed a large amount of ascitic fluid. There were multiple dilated collateral vessels surrounding the duodenum and the distal end of the stomach, as well as multiple collaterals in the anterior abdominal wall. The collaterals were ligated and divided in the anterior abdominal wall. The duodenum was generously cauterized and devascularization of the duodenum was done by multiple ligations and divisions of the collaterals surrounding the duodenum. Then, the distal part of the stomach was dealt with in the same way, by ligation and division of the collaterals.

It is my understanding that since the upper GI was converted to an exploratory Lap, in which the collaterals (branches of blood vessels) are being ligated/repaired that I would use code 35221? I find no other appropriate code, as all others refer to repair of gastro-esophogeal varicies. The only other one I thought may work was 43840, but that's under bariatric surgery or maybe an unlisted code with the report?