hsmith67
Guru
Please help me code this one!! Thanks for any assistance.
Patient had gastrostomy tube placed, increased leakage was noticed, presented to ER and patient admitted to manipulating the gastrostomy tube. Was taken to the ER and below is the Op note:
....Exploration of the former gastrostomy site, which measured approximately 1.5 inches revealed that the gastrostomy tube was in the deep subcutaneous tissue. The gastrostomy tube was removed. There was small discharge noted from a constricted opening presumed to be coming from the stomach. I attempted to clearly identify and define the tiny opening. I had anesthesia place a nasogastric tube followed by infusing dilute solution of methylene blue and normal saline. No leakage was identified. I opened the patient in the upper midline epigastrium. A vertical incision was made on the skin with #10 scalpel. All layers of the abdominal wall was divided and the abdomen area was carefully entered under direct visualization. I noticed gastric content mixed with blue dye in the upper abdomen. The fluid was evacuated with suctioning. I mobilized the stomach from its attachment to the anterior abdominal wall and brought it to the midline with 2 Babcock clamps. I found a golf ball size hole in the stomach with partial necrosis. The Bookwalter retracting system was set up to provide proper exposure. I debrided the necrosis to normal gastric tissue with electrocautery. The ends of the opening were held with Allis clamps. Next, I closed the defect using the approximate reload 60 mm stapler. The end of the gastric tissue was amputated with a #10 scalpel. The staple line was reinforced using a 2-0 silk interrupted sutures. The gastric closure was hemostatic and without leakage. Next, I chose a more proximal site in the fundus for the replacement of the gastrostomy tube. Two rows of pursestrings were placed in the fundus using 2-0 silk sutures. The fascia defect of the former gastrostomy tube site was closed from inside the abdomen with #1 PDS. A site lateral to the former opening in the skinwas chosen for replacement of the gastrostomy tube. A stab incision was made in the skin with #15 scalpel. The MIC 24F feeding gastrostomy tube was brought through the skin and into the abdomen with a blunt Kelly clamp. The mid portion of the pursetring was opened with electrocautery. The site was dilated with a Kelly clamp and the gastrostomy tube was placed into the stomach under direct visualization. The 2 pursetrings were tied sequentially. The bulb of the MIC 24 gastrostomy tube was then filled with 10 mL of sterile water. There was no leakage. The stomach was grasped with a pair of Babcocks and 2 sutures were placed in the stomach and attached to the underside of the anterior abdominal wall just below the site of the gastrostomy tube. Tue suture used to secure the stomach to the underside of the abdominal wall was 0-Vicryl. The surgical site was hemostatic at the end of the case......
Again, any help is very much appreciated!
Hunter Smith, CPC
Patient had gastrostomy tube placed, increased leakage was noticed, presented to ER and patient admitted to manipulating the gastrostomy tube. Was taken to the ER and below is the Op note:
....Exploration of the former gastrostomy site, which measured approximately 1.5 inches revealed that the gastrostomy tube was in the deep subcutaneous tissue. The gastrostomy tube was removed. There was small discharge noted from a constricted opening presumed to be coming from the stomach. I attempted to clearly identify and define the tiny opening. I had anesthesia place a nasogastric tube followed by infusing dilute solution of methylene blue and normal saline. No leakage was identified. I opened the patient in the upper midline epigastrium. A vertical incision was made on the skin with #10 scalpel. All layers of the abdominal wall was divided and the abdomen area was carefully entered under direct visualization. I noticed gastric content mixed with blue dye in the upper abdomen. The fluid was evacuated with suctioning. I mobilized the stomach from its attachment to the anterior abdominal wall and brought it to the midline with 2 Babcock clamps. I found a golf ball size hole in the stomach with partial necrosis. The Bookwalter retracting system was set up to provide proper exposure. I debrided the necrosis to normal gastric tissue with electrocautery. The ends of the opening were held with Allis clamps. Next, I closed the defect using the approximate reload 60 mm stapler. The end of the gastric tissue was amputated with a #10 scalpel. The staple line was reinforced using a 2-0 silk interrupted sutures. The gastric closure was hemostatic and without leakage. Next, I chose a more proximal site in the fundus for the replacement of the gastrostomy tube. Two rows of pursestrings were placed in the fundus using 2-0 silk sutures. The fascia defect of the former gastrostomy tube site was closed from inside the abdomen with #1 PDS. A site lateral to the former opening in the skinwas chosen for replacement of the gastrostomy tube. A stab incision was made in the skin with #15 scalpel. The MIC 24F feeding gastrostomy tube was brought through the skin and into the abdomen with a blunt Kelly clamp. The mid portion of the pursetring was opened with electrocautery. The site was dilated with a Kelly clamp and the gastrostomy tube was placed into the stomach under direct visualization. The 2 pursetrings were tied sequentially. The bulb of the MIC 24 gastrostomy tube was then filled with 10 mL of sterile water. There was no leakage. The stomach was grasped with a pair of Babcocks and 2 sutures were placed in the stomach and attached to the underside of the anterior abdominal wall just below the site of the gastrostomy tube. Tue suture used to secure the stomach to the underside of the abdominal wall was 0-Vicryl. The surgical site was hemostatic at the end of the case......
Again, any help is very much appreciated!
Hunter Smith, CPC