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Graham Patch For Duodenal Ulcer

  1. #1
    Location
    Pittsburgh Central
    Posts
    75
    Default Graham Patch For Duodenal Ulcer
    Medical Coding Books
    Does anyone have any suggestions for coding a Graham patch to repair a duodenal ulcer?

    Would it be 43840 or add-on 49905? Am I close???

    Thanks for any advice!

  2. #2
    Location
    Johnson City
    Posts
    202
    Default
    I believe you are correct. This is how I code for Graham Patch repair of a duodenal ulcer.
    Melissa CPC

  3. #3
    Location
    Pittsburgh Central
    Posts
    75
    Default
    Quote Originally Posted by mjewett View Post
    I believe you are correct. This is how I code for Graham Patch repair of a duodenal ulcer.
    Melissa CPC
    Do you use both CPTs?

    Thank you very much for your help.

  4. #4
    Location
    Johnson City
    Posts
    202
    Default
    Yes, I use both 43840 and add-on 49905. 43840 is the suture repair of a duodenal ulcer... and code 49905+ is the omental flap intra-abdominal. The doctor creates the omental flap and sutures it to the site of the duodenal ulcer/wound to repair it.

    I use to get tripped up over this one too.

    Melissa-CPC

  5. #5
    Location
    Pittsburgh Central
    Posts
    75
    Default
    Thank you so much!

  6. #6
    Default
    Billed as you show above and received denial from Medicare stating this is not a valid primary procedure for 49905. They recognize 43840 as payable, but not 49905 stating no appropriate primary procedure billed. (This went to appeal and all)
    Any suggestions?

    ~Melissa Rufenbarger, CPC

  7. #7
    Default
    actually my doc told me the patch is included with the procedure a FLAP wouldbe something way more extensive than a simple patch

  8. #8
    Location
    Des Plaines, IL Chapter
    Posts
    27
    Default duodenorraphy with graham patch
    Hi
    We can code 43840 with 49905 (intraabdominal omental flap) There is no bundling issue per NCCI edits

    Jerry E. Roxas, CPC

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