Hi everyone. I have a question about the Graham Patch. One of our physicians performed a gastrorraphy with a graham patch for a perferated gastric ulcer. In his note he stated that there was already enough omentum to not require further mobilization for good coverage of the perferation. How would I code this? Still use the 43840 w/+49905, or an unlisted code?

Here is an excerpt from the Op Note:

Once the preliminary irrigation had been performed, a biopsy of the ulcer was performed sharply. This was sent for permanent evaluation. There was ample omentum within the vicinity that did not require any mobilization. 4x 0-Vicryl sutures were used to close the perforation primarily. One of the leaflets was left untied to facilitate approximation of the Graham patch along the perforation site. Each one of these leaflets were then tied in continuity with excellent coverage of the perforation. Prior to closure, the nasogastric tube was palpated within the gastric lumen. The abdomen was again copiously irrigated with multiple liters of warm irrigation and all 4 quadrants aspirated until clear. Upon review, there was some friability of the posterior liver edge abutting the perforation with some venous ooze. This was controlled with electrocautery.

Any assistance is very very much appreciated.