janseez
New
Hi,
Does anyone have any advice for the codes for this procedure?
Indication:Gastric bypass complicated by left upper quadrant collection secondary to gastric mucosa remnant. Patient presentsfor repositioning of drainage catheter into the gastric remnant via a transgastric route to facilitate internal drainage.
The indwelling drainage catheter was injected and images taken. Catheter was removed over a wire, and a 9-French sheath & safety wire was placed An En Snare was placed via a nasogastric route and opened in the gastric lumen. A gastric cannula was advanced with tip directed towards the stomach. A 21-gauge trocar needle was advanced into the stomach lumen & position confirmed by contrast injection. A V-18 wire was advanced through the 21-gauge trocar, snared and pulled from the nasal passage creating 'body floss" wire from the tube track to the nare. From the abdominal percutaneous tract, a Jeffrey set was advanced over the wire. Exchange was made for a 0.035 Roadrunner wire, and the tract into the stomach was dilated to 14-French.
With the vascular sheath and gastric cannula now located within the gastric lumen and directed towards the gastric remnant, a 21-gauge trocar needle was advanced into the gastric remnant. Needle location confirmed by contrast injection. A V-18 wire was advanced and the gastric remnant, over which the Jeffrey set was placed again to gain more stable access. A super stiff Amplatz wire was advanced into the gastric remnant, and the entire track was dilated to 14-French. A 14-French abscess drainage catheter was placed (its course being trans-gastric with pigtail tip located in the gastric remnant) with additional side holes made to drain into the stomach. Post placement injection was performed. The tube was sutured in place and attached to a gravity drainage bag.
The physician wishes to bill 49440, 49021, 75989.
Since the the tube is used for drainage, I do not agree with 49440. I suggested to drop the49440 and add 49424, 76080 for the existing tube check but he disagreed since this is not an abscess. He feels that procedure consists of the work of a g-tube and that holes were placed in the stomach. He stated that the collection is a piece of isolated stomach which is being connected to the stomach. Unlisted codes are fiercely objected to.
Any suggestions will be greatly appreciated.
Thank you!
Jeanette Seesholtz, CPC, CIRCC
Does anyone have any advice for the codes for this procedure?
Indication:Gastric bypass complicated by left upper quadrant collection secondary to gastric mucosa remnant. Patient presentsfor repositioning of drainage catheter into the gastric remnant via a transgastric route to facilitate internal drainage.
The indwelling drainage catheter was injected and images taken. Catheter was removed over a wire, and a 9-French sheath & safety wire was placed An En Snare was placed via a nasogastric route and opened in the gastric lumen. A gastric cannula was advanced with tip directed towards the stomach. A 21-gauge trocar needle was advanced into the stomach lumen & position confirmed by contrast injection. A V-18 wire was advanced through the 21-gauge trocar, snared and pulled from the nasal passage creating 'body floss" wire from the tube track to the nare. From the abdominal percutaneous tract, a Jeffrey set was advanced over the wire. Exchange was made for a 0.035 Roadrunner wire, and the tract into the stomach was dilated to 14-French.
With the vascular sheath and gastric cannula now located within the gastric lumen and directed towards the gastric remnant, a 21-gauge trocar needle was advanced into the gastric remnant. Needle location confirmed by contrast injection. A V-18 wire was advanced and the gastric remnant, over which the Jeffrey set was placed again to gain more stable access. A super stiff Amplatz wire was advanced into the gastric remnant, and the entire track was dilated to 14-French. A 14-French abscess drainage catheter was placed (its course being trans-gastric with pigtail tip located in the gastric remnant) with additional side holes made to drain into the stomach. Post placement injection was performed. The tube was sutured in place and attached to a gravity drainage bag.
The physician wishes to bill 49440, 49021, 75989.
Since the the tube is used for drainage, I do not agree with 49440. I suggested to drop the49440 and add 49424, 76080 for the existing tube check but he disagreed since this is not an abscess. He feels that procedure consists of the work of a g-tube and that holes were placed in the stomach. He stated that the collection is a piece of isolated stomach which is being connected to the stomach. Unlisted codes are fiercely objected to.
Any suggestions will be greatly appreciated.
Thank you!
Jeanette Seesholtz, CPC, CIRCC
I know i know