Could someone give me their opinion on the following surgery? I used an unlisted code and it was denied.

Post Op DX--iatrogenic damage to the gastric fundus

Operation: 1. Exploratory laparotomy (through the prior left upper quadrant kocher incision). 2. Repair of the distal stomach (patient status post roux-en-y gastric bypass) 3. gastric tissue flap (essentially brought the greater curve of the stomach up to put a second layer on this fundal repair). 4. Irrigation and drainage.

This woman had a very large procedure yesterday. She had left upper quadrant exploration by Dr. 1 and then had a thoractomy by Dr. 2. There was some debridement of a fair amount of diaphragm by Dr. 2 and repair of that diaphragm. The patient has put out bile throughout the lateral part of the abdominal wound.

General anesthetic was induced without complication. The patient was carefully placed on the OR bed and carefully positioned and padded. her gastric tube was prepped in the field. this was done with a betadine prep, she was draped. Dr. 1 removed the staples from the incision, removed the sutures from the incision. there was a lot of bile stained material. Dr 1 followed this up cephalad and on the apex cephalad fundus there was mucosal pouting in a hole in the stomach. I repaired in several layers, first interrupted 2-0 silk suture primarily and a second layer of interrupted 2-0 silk suture. I then placed fibrin glue on this repair and then placed two drains through two separate stab incisions, one lateral and one medial, the most lateral went around the top of the spleen towards the tip of the leak. that leak was on the medial portion of the spleen and cephalad tip of the spleen. The next one came in from medial and was placed on the lower greater curve area. These were secured with nylon 2-0 suture. I then rinsed out the entire abdomen copiously with several liters of fluid until clear. I evacuated that fluid. I closed her then in a running #1 PDS suture. I then irrigated the subcutaneous layers copiously and then closed the skin with skin clips.