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Migration of Nissen

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    Default Migration of Nissen
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    This is the first Nissen revision for me. I don't know if it is just me but it seems that there is much more going on here. Please read the op note below and let me know if you think that I am going in the right direction:

    Post op dx:
    1 hiatal hernia
    2 migration of nissen fundoplication

    Procedure: Laparoscopic hiatal hernia repair

    "Once the trocar was intraperitoneal, the abdomen was infiltrated with carbon dioxide to a pressure of 15mmHg. The previous subxiphoid trocars ite was injected with Marcaine and opened with a #11 blade. The obturator to a 5mm bladeless trocar was used to create a tract thru which the Nathonson retractor was placed. The left lobe of the liver was elevated, and the Nathonson was secured on the bookwalter arm. The previous trocar sites were all injected with Marcaine. A Babcock was used to protract the stomach toward the feet and laterally. Adhesions were taken down between the right crus and the esophagus using the Gyrus as well as sharp dissection. Dissection was carried out anteriorly. A large portion of the stomach was herniated on the left side. The stomach was retracted down with a Babcock, and adhesions into the chest were taken down primaryily with the Gyrus. Extensive adhesiolysis was undertaken until the stomach was completely back down in the abdominal cavity. Some adhesions were taken down from the left crus as well. Attention was then turned back to the right crus. The tacking suture of the wrap to the right crus was divided with scissors. Dense adhesions were then tediously taken down but ultimately this was accomplished leaving the wrap intact. Once the wrap was completely back down into the abdomen along the right side, attention was then turned to closing the hernia defect. A small deserosalized area on the anterior part of the stomach was oversewn with 2-0 silk sutures. The hiatus was then closed...."

    What I came up with is 43280 and I am not completely comfortable with that either. I think that there is more here to code but I am not sure what it is. Is it the lysis of all of the adhesions? I thought that that was incident to the surgery itself. Do I just add a -22? Please help with this one...
    Last edited by LTibbetts; 11-05-2009 at 11:59 AM.

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