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Thread: HELP!! Repair of duodenal fistula

  1. #1
    Join Date
    Apr 2007
    Greenville NC

    Question HELP!! Repair of duodenal fistula

    AAPC: Back to School
    I have a surgeon that is charging an open cholecystectiomy with repair of duodenal fistula with Roux-en-Y, jejunoduodenostomy. The fistula was repaired because the gallbladder had eroded down into the duodenum. I've got the open chole but not sure how to code the other part...HELP!!

  2. #2
    Join Date
    Apr 2007
    Kansas City, MO


    I really can't say without seeing an op.

    You might take a look at the "repair section" starting at 47720.

  3. #3
    Join Date
    Apr 2007
    Greenville NC


    Description of Procedure:


    The gallbadder was entered and then stones were scooped out enough to fill a large basin. The entry of the gallbladder wall was then resected. Attempt at tracing the gallbladder distally was taken meticulously. Dr muller was called in and helped with the case,. the gallbladder was so large that it was compressing and pushing on the duodenum and abdominal visceral structures..

    Careful dissection locating a plane between the gallbladder and the duodenum there was a paper thin area of duodenum that had been eroded by the gallbladder. This opened and drained during the operation. After attempts at removing as much gallbladder safely as possible were performed, a Roux-e-Y was created by locating the ligament of Treitz, dividing the jejunum about 40cm distal to the ligament of Treitz and then carefully taking down the mesentery to create a Roux limb of jejunum.

    A enterostomy was then perfored using a side-to-side staple anastomosis to form the wide portion of the Roux-en-Y. This was broght in a retrocolic fashion and a jejunoduodunostomy was then fashioned as a single layer closure between the end of the Roux limb and the duodenum. This was performed with silk and Vicryl Sutrues.

    A drain was placed posterior and anterior to this closure and then exited through a seperate stab incision. The abdomen was copiously irrigated and then the extended subcostal incision was then closed with 2 lyers of running PDS and 0 interrupted Vicryl popoff. A drain was left in the subcu. A fat sutrue was then placed wi running 3-0 Vycryl and skin closed wih skin staples. The patient was taken to the ICU the recovery.

    Brandy Edmondson CPC

  4. #4
    Join Date
    Apr 2007


    see if this code works, its a "separate procedure" may be integra to your primary procedure, see CCI edits.

    Cholecystotomy or cholecystostomy, open, with exploration, drainage, or removal of calculus (separate procedure)

    Lay Description

    The physician performs an open cholecystotomy or cholecystostomy with exploration, drainage, or removal of calculus. The physician exposes the gallbladder through a subcostal or upper midline incision. The gallbladder is incised, explored, and may be drained. Calculi may be removed. The gallbladder is closed with interrupted sutures primarily or around a drainage tube. If placed, the drainage tube is brought out through the skin at a site separate from the incision.

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