lilleyea
Networker
Does anyone know what code should be used for an open Roux-en-Y gastrojejunostomy? It was for gastric outlet obstruction. Here is the part of the op note in question:
"Once adequate adhesiolysis was performed, attention was turned to the stomach. The lesser sac was entered, and the stomach mobilized. There was dense adhesive tissue from the pylorus to the underlying head of the pancreas and porta. The decision was made that it was not safe to proceed with the proposed antrectomy for fear of injury to the portal structures and head of the pancreas. The decision was made to proceed with a Roux-en-Y gastrojejunostomy. The retrocolic space was performed. The site was selected after confirming the location of the ligament of Treitz. The GIA was used to divide the bowel, and the mesentery divided using the LigaSure system. The Roux limb was passed through the retrocolic space, and a side-to-side functional end-to-end anastomosis created from the stomach to the small bowel using the GIA stapler. The resulting defect was closed in layered fashion using 3-0 Vicryl in a running baseball fashion followed by a silk interrupted Lembert layer. The jejunojejunostomy was then performed using the GIA stapler. The resulting defect was also closed with a stapler and with a running Vicryl and silk stitch in an identical fashion. The NG tube was passed through the gastrojejunostomy into the Roux limb and secured at the nose. The abdomen was irrigated with copious amounts of warm normal saline until the effluent ran clear. At the completion of the procedure, the anastomosis was once again examined and found to be patent, adequate, and well vascularized. The closure was performed in a simple running fashion using a #1 double stranded PDS suture through all layers. The skin was irrigated, and meticulous hemostasis obtained. The skin was then closed using a surgical stapling device. At the completion of the procedure, the patient is pending transfer to the recovery room. She appears to be in stable condition. There were no complications, and all counts were said to be correct."
I can find the code for gastrojejunostomy 43820, but this does not describe the Roux-en-Y procedure. I have also found 43621 and 43633, but a gastrectomy was not performed. I am at a loss in how to code this. Any suggestions are most appreciated!
"Once adequate adhesiolysis was performed, attention was turned to the stomach. The lesser sac was entered, and the stomach mobilized. There was dense adhesive tissue from the pylorus to the underlying head of the pancreas and porta. The decision was made that it was not safe to proceed with the proposed antrectomy for fear of injury to the portal structures and head of the pancreas. The decision was made to proceed with a Roux-en-Y gastrojejunostomy. The retrocolic space was performed. The site was selected after confirming the location of the ligament of Treitz. The GIA was used to divide the bowel, and the mesentery divided using the LigaSure system. The Roux limb was passed through the retrocolic space, and a side-to-side functional end-to-end anastomosis created from the stomach to the small bowel using the GIA stapler. The resulting defect was closed in layered fashion using 3-0 Vicryl in a running baseball fashion followed by a silk interrupted Lembert layer. The jejunojejunostomy was then performed using the GIA stapler. The resulting defect was also closed with a stapler and with a running Vicryl and silk stitch in an identical fashion. The NG tube was passed through the gastrojejunostomy into the Roux limb and secured at the nose. The abdomen was irrigated with copious amounts of warm normal saline until the effluent ran clear. At the completion of the procedure, the anastomosis was once again examined and found to be patent, adequate, and well vascularized. The closure was performed in a simple running fashion using a #1 double stranded PDS suture through all layers. The skin was irrigated, and meticulous hemostasis obtained. The skin was then closed using a surgical stapling device. At the completion of the procedure, the patient is pending transfer to the recovery room. She appears to be in stable condition. There were no complications, and all counts were said to be correct."
I can find the code for gastrojejunostomy 43820, but this does not describe the Roux-en-Y procedure. I have also found 43621 and 43633, but a gastrectomy was not performed. I am at a loss in how to code this. Any suggestions are most appreciated!
