Results 1 to 5 of 5

Thread: gastrojejunostomy stricture question

  1. #1
    Join Date
    Apr 2007
    Location
    Dickson, TN
    Posts
    160

    Default gastrojejunostomy stricture question

    My question is regarding CPT billing and Icd-9 as well. My situation is as follows. On a gastric bypass patient, who is 3 years out from her bypass surgery returns to OR for an EGD, the physician performs the EGD and dilates the anastomosic site from the bypass. THis is done through the scope. I did not bill it with CPT 43245 as it says Gastric Outlet obstrustion as this is an anastomosis. I also billed with ICD-9 code for complication of surgery diagnsis 997.1. The doctor says this is the patients gastric outlet therefore, the 43245 and the 537.0 should have been billed. that since the patient is three years out from her surgery it can not be considered a complication of the surgery.
    I need some imput and if anyone has anything written in black and white as back up I would appreciate that as well.
    If I am wrong I will gladly resubmit a corrected claim.

    Thanks
    Debbie Potts England
    Lyles, TN 37098

  2. #2

    Default

    Well I hate to tell you...but I think your Dr. is right. I see this a lot, 3 years out I would not consider that to be a complication from the Sx, although Gastric Outlet Obstruction is quite common in bypass patients. I would code it as:
    43245 – 537.0, V45.86

    Michael D. Reyland, CPC, CIRCC
    Surgical Specialists of Georgia
    Gainesville, GA

  3. #3
    Join Date
    Apr 2007
    Location
    Oak Ridge
    Posts
    14

    Question esophagogastroduodenoscopy with dilation anastomotic stricture

    I question the use of the 43245 as this is not a patient with normal anatomy and is not in the "bariatric surgery" section.

    Our patient had suspected anastomotic performation six weeks out and a diagnostic laparopscopy was performed finding only fat adhesed to the anastomosis that was gently dissected. Next he did an esophagogastroduodenoscopy and Savory dilation of the anastomosis beginning with 18-French, then up to 21- French, 24-French, 27-French 30-french and finally 33-French with no evidence of leak.

    Since the patient is still in global to the original Lap Roux-en-Y gastric bypass, we are conserned with using a code that is not "bariatric" related as this could be misleading to the INS that is it not bariatric complication. We have considered the use of unlisted code 43659 (of course this is laparoscopic, but there is no unlisted endoscopic code) and this is a "revision" of the prior gastric restrictive procedure which if it were an open procure would be 43848 for i.e. non-empting gastric pouch. So for revisions we generally use the 43659 (Laparscopic).

    I am looking for professional bariatric advise regarding some of the revision procedures, i.e. my case above and if it is okay to use the 43245 even though it is not a "bariatric" code.

    Thanks,

  4. #4
    Join Date
    Apr 2007
    Location
    Denver CO
    Posts
    77

    Talking Gastric Outlet Obstruction

    My opinion would be to agree with the original physician's take on this. Although the patient had a gastric bypass, the surgery simply lessened the amount of "gastric" available for digestion. The physician re-approximated the jejunum to a different spot on the stomach but this is still the outlet. 43235 is the correct code. Use of the V45.86, included with the outlet obstruction code, will give the insurance company the full story. There is no need to try to find a code from the Bariatric section as it's three years out and this is now the patient's "normal" anatomy.

    Torilinne
    CPC, CGIC

  5. #5
    Join Date
    Apr 2007
    Location
    Oak Ridge
    Posts
    14

    Default

    2017 ICD-10-CM Coding Book
    Okay, but what about i my case that is only 6 weeks status post. What determines a timeframe of when it would not be a complication of the prior bariatirc surgery. Had they not had that procedure, they would not be having this stricture. The 43848 covers most complications, except that it is an open code.

Similar Threads

  1. Laparoscopic gastrojejunostomy
    By jan g in forum Gastroenterology
    Replies: 0
    Last Post: 03-25-2014, 04:08 PM
  2. Gastrojejunostomy placement
    By umcanes4 in forum Gastroenterology
    Replies: 0
    Last Post: 12-18-2013, 08:17 AM
  3. gastrojejunostomy tube dislodgement
    By ggparker14 in forum Diagnosis Coding
    Replies: 3
    Last Post: 07-07-2013, 11:40 PM
  4. Kinked gastrojejunostomy tube
    By chembree in forum Interventional Radiology
    Replies: 0
    Last Post: 05-17-2013, 09:11 AM
  5. Roux-en-y gastrojejunostomy
    By LindaEV in forum General Surgery
    Replies: 1
    Last Post: 11-30-2009, 08:57 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.