Wiki New to general surgery coding - is this CPT 34848?

barbf

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I've just stared doing general surgery and need some help. Based on the following report, would this be a revision? CPT 34848?

We began through a generous midline incision. Entered the abdomen, lysed adhesions and mobilized the liver. Reflected the liver and was able to get the stomach off this. We then mobilized the greater curvature of the stomach. Isolated the crus, encircled the esophagus at the hiatus. Closed the crus posteriorly using #1 Ethibond. I then removed the Silastic ring and opened the pouch just above the Silastic ring and palpated within it. We placed the anvil of a 25 EEA into the pouch and stapled around the pouch, above the band and along the previous staple line. I then resected the area of the previous band, where I made the gastrotomy. I then created a Roux limb, dividing the jejunum distal to the ligament of Treitz and taking one arcade of vessels. I created a long Roux limb of approx. 75 cm and stapled the base of this using a tan load on the stapler and oversewed the enterotomies using 3-0 PDS and fixed the mesenteric defect using 3-0 silk. I took the end of the Roux limb staple line off and brought the EEA 25 stapler through this and brought it through the side of the jejunum and created an anterior pouch to side jejunal anastomosis with a 25 EEA. Two donuts. I palpated from the inside and stapled across the open end of the Roux limb using a tan load. Endoscopy performed, anastomosis insufflated both as well as the pouch. No narrowing of the GE junction. Then put a G tube into the remnant stomach. A 24 Foley was brought through the right sided stab site, placed into the gastrotomy. Balloon inflated and pursestring tied. Created a Witzel tunnel using 2-0 silk over this and left intracorporeally. Closed with #1 PDS followed by staples.
 
Good morning

I think the code you were trying to suggest was 43848 for revision of a prior gastric restrictive procedure. That is definitely a possibility here. Does your note by chance have the patient's surgical history in the indications/history section? I ask because 43848 is for revision of a prior gastric restrictive surgery other than an adjustable gastric restrictive device (i.e., a band). In the note here, there is a Silastic ring mentioned which is what a lap band (aka adjustable gastric restrictive device) is made of. So if they were just removing a lap band and creating another gastric restrictive configuration (like a pouch and a Roux-en-Y) for the first time, we would not code 43848. But they also mention stapling the pouch "above the band and along the prior staple line" making it sound like the patient had a pouch created by stapling. It's possible the patient had multiple prior gastric restrictive surgeries, one with an adjustable band, and one that is more fixed with the staples. If that is the case, 43848 would be appropriate - just wanted to confirm the surgical history before confirming that as the final code.

I hope that helps. Let me know if you have more details on the past surgeries, and happy to weigh in on the final coding.

Kim
www.codingmastery.com
 
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