I need help, this operative report has me pulling out my hair.
Here are listed procedures
1. EGD- Diagnostic
2. Laparoscopic Esophagectomy with a right mini-thoracotomy (IVOR LEWIS)
3. Mediastinal lymph node dissection
4. Takedown of Previous gastrostomy, with lysis of adhesions taking 1 hour of extra time
43117 is for the Ivor Lewis esophagectomy, if done with a Thoracotomy, and seperate abdominal incision. Since he did the abdominal portion laparoscopically, I was unsure if I should bill that part with unlisted code 43289 and bill for the thoracotomy portion with 43121????
Next, should I bill for the takedown of the gastrostomy, or would you consider this an integral part of 44121?
There are no CPT codes for lysis of abominal adheisions, should I add modifer 22. OR should I just consider this in with thoracotomy approach?
I can give more details from the op note, if you need.
Thanks for help ahead of time!
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