Wiki Pylorus preserving pancreatectomy with dunking pancreaticogastrostomy

[SheilaY]

Hello,
Was hoping to get some input on this surgery. In the reconstruction the pancreas is dunked into the stomach and attached with sutures rather than anastomosed to the jejunum because of a very small duct . The other reconstructions are hepaticojejunostomy and duodenojejunostomy. So there are three connections just like in 48153. What I am not sure about is if this is enough of a difference not to use 48153 or should I be billing the unlisted code, 48999? Also, if I billed 48154 I wouldn't give credit for the third anastomosis.
Thanks.

 

[peltanderson]

Whipple with Pancreaticogastostomy

I am having the same issue, I am leaning toward 48154-22. I have searched for documentation and have not had any luck. I feel that using 48153 would not be appropriate and using unlisted codes is always a payment challenage.

Any other opinions out there or does anyone else have any documentation?

Thanks!
Myra