lorrib
Contributor
NEED HELP with multiple junostomies, PLEaSe
Hi,
I am having a bit of difficulty coding the following surgery which contained all of the following procedures:
Cholecystojejunostomy
Gastrojejunostomy
Jejunojejunostomy
Celiac Plexus Block
Gastrostomy Tube Placement
Fine-Needle Aspiration Biopsy of Pancreatic Mass
I was thinking of code 47741 for the cholecystojejunostomy and gastrojejunostomy. I am wondering about 44130 for the jejunojejunostomy and 64530 for the celiac plexus injections? I am assuming that the gastrostomy tube placement would be bundled with jejunostomy procedures. Can someone please take a look at the surgery and offer advice?
Procedure Description:
An incision was made from the xiphoid to the umbilicus with a scalpel and dissection was carried down bluntly and with cautery to the midline fascia, which was opened with cautery. ........The mass was located and this was approached through gastrocolic omentum in the lesser sac. Two or three pases with a xx guage fine needle were taken, resulting in one specimen. Attention was then turned to the bypass at hand. The loop of jejunum approximately 80 to 100 cm from the ligament of Treitz was brought up easily to the gallbaldder, which was not diseased. Seromuscular stay sutures of 4-0 silk were placed and a row of seromuscular Lember sutrures was created. The gallblader was opened and suction of clear bile. The jejunum was opened and posterior row of locking 4-0 PDS suture was used to create the posterior wall of the anstomosis transitioning to a Connell stick anteriorly. The anastomosis was approximately 4 cm in length. The anastomosis was reinforced using interrupted 4-0 silk Lember sutures. The retrocolic gastrojejunostomy was then fashioned bringing the portion of the stomach through the transverse mesentery. Again, the anastomosis was fashioned in approximately 25 cm from the ligament of Treitz in an antegrade fasion with seromuscular stay stures of 4-0 silk placed first, followed by a posterior row of seromuscular Lembert sutures. The stomach and the jejunum was opened and the posterior locking 3-0 PDS suture was used to create the posterior wall of the anstomosis transitioning to a Connell stick anteriorily reinforced with a row of interrrupted Lembert sutures. The Jejunojejunostomy was then fashioned along the antimesenteric border of the jejunum approximately 20 cm distal to the gastrojejunostomy and was approximately 6 cm in length. The Bookwalter retractor was removed. The aorta approached through the gastrohepatic omentum and the takeoff of the celiac artery was palpated via a palpable thrill. A 20 ml 50% ethanol were injected into the area of the celiac plexus in the periaortic area on the right and left sides on the anterolateral surface of the aorta. The syringe was aspirated prior to the injection and the new area of injections ascertained no entry into the vascular structure. The patient tolerated this procedure will. The gastric body was then mobilized into the operative field and a point in the left upper quadrant of the gastric boddy was located for the gastrostomy. The stomach was sutured to the planned posterior rectus sheath using interrupted 3-0 silk sutures. Laterally, the 18-French gastrostomy tube was then passed into the peritoneum via a stab incision. The gastrostomy tube placed into the stomach and the balloon inflated. The stomach was then tacked to the posterior rectus fascia circumferentially around the gastrostomy tube using 3-0 silk sutures. Fluted JP drains were passed from the peritoneum on the right side of the incisions,. ........
Hi,
I am having a bit of difficulty coding the following surgery which contained all of the following procedures:
Cholecystojejunostomy
Gastrojejunostomy
Jejunojejunostomy
Celiac Plexus Block
Gastrostomy Tube Placement
Fine-Needle Aspiration Biopsy of Pancreatic Mass
I was thinking of code 47741 for the cholecystojejunostomy and gastrojejunostomy. I am wondering about 44130 for the jejunojejunostomy and 64530 for the celiac plexus injections? I am assuming that the gastrostomy tube placement would be bundled with jejunostomy procedures. Can someone please take a look at the surgery and offer advice?
Procedure Description:
An incision was made from the xiphoid to the umbilicus with a scalpel and dissection was carried down bluntly and with cautery to the midline fascia, which was opened with cautery. ........The mass was located and this was approached through gastrocolic omentum in the lesser sac. Two or three pases with a xx guage fine needle were taken, resulting in one specimen. Attention was then turned to the bypass at hand. The loop of jejunum approximately 80 to 100 cm from the ligament of Treitz was brought up easily to the gallbaldder, which was not diseased. Seromuscular stay sutures of 4-0 silk were placed and a row of seromuscular Lember sutrures was created. The gallblader was opened and suction of clear bile. The jejunum was opened and posterior row of locking 4-0 PDS suture was used to create the posterior wall of the anstomosis transitioning to a Connell stick anteriorly. The anastomosis was approximately 4 cm in length. The anastomosis was reinforced using interrupted 4-0 silk Lember sutures. The retrocolic gastrojejunostomy was then fashioned bringing the portion of the stomach through the transverse mesentery. Again, the anastomosis was fashioned in approximately 25 cm from the ligament of Treitz in an antegrade fasion with seromuscular stay stures of 4-0 silk placed first, followed by a posterior row of seromuscular Lembert sutures. The stomach and the jejunum was opened and the posterior locking 3-0 PDS suture was used to create the posterior wall of the anstomosis transitioning to a Connell stick anteriorily reinforced with a row of interrrupted Lembert sutures. The Jejunojejunostomy was then fashioned along the antimesenteric border of the jejunum approximately 20 cm distal to the gastrojejunostomy and was approximately 6 cm in length. The Bookwalter retractor was removed. The aorta approached through the gastrohepatic omentum and the takeoff of the celiac artery was palpated via a palpable thrill. A 20 ml 50% ethanol were injected into the area of the celiac plexus in the periaortic area on the right and left sides on the anterolateral surface of the aorta. The syringe was aspirated prior to the injection and the new area of injections ascertained no entry into the vascular structure. The patient tolerated this procedure will. The gastric body was then mobilized into the operative field and a point in the left upper quadrant of the gastric boddy was located for the gastrostomy. The stomach was sutured to the planned posterior rectus sheath using interrupted 3-0 silk sutures. Laterally, the 18-French gastrostomy tube was then passed into the peritoneum via a stab incision. The gastrostomy tube placed into the stomach and the balloon inflated. The stomach was then tacked to the posterior rectus fascia circumferentially around the gastrostomy tube using 3-0 silk sutures. Fluted JP drains were passed from the peritoneum on the right side of the incisions,. ........
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