Hello,
Can someone please help me code the follwing sx: Not sure of the codes for the BX's.
I am looking at these codes: 44110-small bowel Bx
49441 or 44015-JJ tube ( what is the difference in using those codes for the JJ tube?)
or 44110,49010 and the JJ tube, which I believe may be bundled.
Will Need to use a 59 as well?

DATE:
PREOPERATIVE DIAGNOSIS: Gastric carcinoma.
POSTOPERATIVE DIAGNOSIS: Metastatic stage IV gastric cancer.
NAME OF OPERATION:
1 Exploratory laparotomy.
2 Biopsy of peritoneum.
3 Small bowel biopsy.
4 Feeding jejunostomy.
SURGEON:
ASSISTANT:
ANESTHESIA:
ESTIMATED BLOOD LOSS: About 10 cc.
GROSS OPERATIVE FINDINGS: Upon entering the abdomen through a
standard mid abdominal incision, right away we noticed peritoneal
seedings and findings consistent with carcinomatosis. In addition, he
had carcinomatosis to the peritoneum and to the small bowel mesentery.
He also had a large amount of ascites. He had a stomach cancer which
involved about 90% of the stomach. The cancer was posteriorly
adherent to the area of the vena cava and aorta. Laterally, again, it
was also very adherent to the aorta and making it impossible for a
safe resection. The entire small bowel mesentery was involved with
metastatic cancer, making this unresectable disease. At this time,
several biopsies were obtained. We took biopsies of the small bowel
mesentery and biopsies of the peritoneum, and this frozen section
showed it to be metastatic adenocarcinoma. A feeding jejunostomy was
then placed.
We chose an area about 10 cm from the ligament of Treitz, 2-0 silk was
used to make a pursestring in the antimesenteric border of the small
bowel. An 18 French T-tube was used. It was cut and fashioned,
placed into the abdomen through a separate stab wound incision in the
left upper quadrant. It was placed into the small intestines and the
pursestring was tied. The small intestine was then tacked to the
anterior abdominal wall using 2-0 silk. At this time, closure was
performed. Closure was done by running the fascia with #1 PDS and
then the skin incision was closed with staples. Patient tolerated the
procedure quite well. He was then taken to recovery in stable
condition.

Thanks!